Organization
BRADSHAW MOUNTAIN DIAGNOSTIC LABORATORY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TOM FELLOWS (PRESIDENT)
(928) 778-7823
Entity
Organization
Contact information
Practice address
990 WILLOW CREEK RD, PRESCOTT, AZ 86301-1640
(928) 778-7823
(928) 778-9419
Mailing address
990 WILLOW CREEK RD, PRESCOTT, AZ 86301-1640
(928) 778-7823
(928) 778-9419
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
050576
—
AZ
Enumeration date
09/23/2005
Last updated
08/22/2020
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