Organization
PROVISTA HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARUN JOLLY (OWNER)
(504) 236-4030
Entity
Organization
Contact information
Practice address
17301 N PERIMETER DR, SUITE 100, SCOTTSDALE, AZ 85255-5468
(602) 224-5500
Mailing address
17301 N PERIMETER DR, SUITE 100, SCOTTSDALE, AZ 85255-5468
(602) 224-5500
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
03D1063366
AZ
Other
Enumeration date
12/18/2007
Last updated
09/13/2019
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