NPI 1003802075

Bradshaw Mountain Diagnostic Laboratory INC.

Organisation Clinical Medical Laboratory Prescott, AZ

Practice location

Address: 990 Willow Creek Rd, Prescott, AZ 86301-1640
Phone: (928) 778-7823
Fax: (928) 778-9419

Authorised official

Name: Tom Fellows
Title: President
Phone: (928) 778-7823

Registered specialties

Clinical Medical Laboratory Primary

Laboratories Taxonomy 291U00000X

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Registry record

NPI: 1003802075
Entity type: Organization
NPI issued: 23 Sep 2005
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.