BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC (NPI# 1144476896) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144476896 |
| Entity Type | Organization |
| Organization Name | BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC |
| Practice Address |
203 S Candy Ln Suite 115-b2 Cottonwood AZ 86326-4120 |
| Mailing Address |
990 Willow Creek Rd Prescott AZ 86301-1640 |
| Practice Telephone | 9286340495 |
| Practice Fax Number | 9286340565 |
| Mailing Telephone | 9287787823 |
| Mailing Fax Number | 9287789419 |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2008-08-13 |
| Authorized Official Name | TOM FELLOWS (PRESIDENT) |
| Authorized Official Telephone | 9287787823 |
| Is Organization Subpart | Y |
| Parent Organization Name | BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | Laboratories |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790932820 | Bradshaw Mountain Diagnostic Laboratory Inc | Clinical Medical Laboratory | 7732 East Florentine Rd, Prescott Valley, AZ 86314 | 2008-08-20 |
| 1508012253 | Bradshaw Mountain Diagnostic Laboratory Inc | Clinical Medical Laboratory | 579 W Wickenburg Way, #8, Wickenburg, AZ 85390-4300 | 2008-08-13 |
| Street Address |
203 S CANDY LN SUITE 115-B2 |
| City | COTTONWOOD |
| State | AZ |
| Zip Code | 86326-4120 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255322871 | Robert Gary Gagliano | Internal Medicine | 203 S Candy Ln, Suite 9a, Cottonwood, AZ 86326-4120 | 2005-11-02 |
| 1215470885 | Angie Coil Fnp Pllc | Nurse Practitioner | 203 S Candy Ln, Suite 13ab, Cottonwood, AZ 86326-4120 | 2016-11-29 |
| 1245691625 | Bella Vita Healthcare | Nurse Practitioner | 203 S Candy Ln, Suite 6ab, Cottonwood, AZ 86326-4120 | 2016-03-14 |
| 1700247509 | Angie Coil | Nurse Practitioner | 203 S Candy Ln, Bldg 13ab, Cottonwood, AZ 86326-4120 | 2016-03-08 |
| 1164882619 | Lhcg Lxxvii, LLC | Home Health | 203 S Candy Ln, Suite 5a, Cottonwood, AZ 86326-4120 | 2016-02-26 |
| 1487042420 | Angela Schilling-koons, Np, LLC | Clinic/Center | 203 S Candy Ln, Bldg 13ab, Cottonwood, AZ 86326-4120 | 2014-12-29 |
| 1205011798 | Joyce L. Richards, D.o. P.C. | Internal Medicine | 203 S Candy Ln, Ste 2a, Cottonwood, AZ 86326-4120 | 2008-01-03 |
| 1689867517 | Sanson Pediatrics, P.C. | Clinic/Center | 203 S Candy Ln, Suite 6b, Cottonwood, AZ 86326-4120 | 2007-08-23 |
| 1467658955 | Daniela Hutyrova | Naturopath | 203 S Candy Ln, Suite 2b, Cottonwood, AZ 86326-4120 | 2007-06-22 |
| 1518088780 | Kimberly Gould | Nurse Practitioner | 203 S Candy Ln, 6ab, Cottonwood, AZ 86326-4120 | 2007-04-03 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679954895 | Isabelle Maisse Griffith | Pharmacist | 1100 E Highway 89a, Cottonwood, AZ 86326 | 2015-06-12 |
| 1184982266 | Northern Arizona Healthcare Provider Group, LLC | Family Medicine | 450 South Willard Street, Cottonwood, AZ 86326 | 2012-04-26 |
| 1922391663 | Ronald D. Carsrud | Hearing Instrument Specialist | 657 E Cottonwood St., Ste 6c, Cottonwood, AZ 86326 | 2011-05-26 |
| 1760712749 | Chuck Thomas Calvano | Pharmacist | 550 S Main, Cottonwood, AZ 86326 | 2010-01-13 |
| 1528231438 | Elizabeth Lightner Mccarrell | Emergency Medicine | 269 S Candy Lane, Cottonwood, AZ 86326 | 2008-04-11 |
| 1972783355 | The Wick Home for Emotional Growth and Recovery | Residential Treatment Facility, Emotionally Disturbed Children | 2102 E Fir St, Cottonwood, AZ 86326 | 2007-11-14 |
| 1750560165 | David T Sayle | Nurse Practitioner | 800 Cove Parkway, Cottonwood, AZ 86326 | 2007-11-01 |
| 1003001033 | Country Care Inc | Assisted Living Facility | 3980 E Cassie Lane, Cottonwood, AZ 86326 | 2007-09-12 |
| 1154527778 | Laurel A Mueller | Family Medicine | 51 Brian Mickelsen Pkwy, Community Health Center of Yavapai, Cottonwood, AZ 86326 | 2007-06-21 |
| 1841401700 | Bruce Alan Moseng | Chiropractor | 240 Jennifer Lane, Ste 103, Cottonwood, AZ 86326 | 2007-05-24 |
| Find all providers in zip 86326 | ||||
| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336284942 | No Ariz Dermatology Center | Clinical Medical Laboratory | 297 S Willard St, Cottonwood, AZ 86326 | 2007-02-21 |
| 1619121423 | Laboratory Corporation of America | Clinical Medical Laboratory | 115 S Candy Ln, Ste B2, Cottonwood, AZ 86326-4105 | 2008-11-06 |
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| 1780203638 | Translational Genomics Research Institute | Clinical Medical Laboratory | 3051 W Shamrell Blvd Ste 106, Flagstaff, AZ 86005-9435 | 2020-04-10 |
| 1710512389 | Path Analytics Laboratory LLC | Clinical Medical Laboratory | 13402 N Scottsdale Rd Ste B195, Scottsdale, AZ 85254-4066 | 2020-03-04 |
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| City | COTTONWOOD |
| Zip Code | 86326 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.