Organization
ARIZONA STATE PUBLIC HEALTH LABORATORY
Active
Parent organization
STATE OF ARIZONA
Other names
ADHS Newborn Screening Program
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF ARIZONA
Authorized official
DR. VICTOR WADDELL PH.D. (BUREAU CHIEF)
(602) 364-0609
Entity
Organization
Contact information
Practice address
250 N 17TH AVE, PHOENIX, AZ 85007-3231
(602) 542-0897
(602) 542-0102
Mailing address
PO BOX 25046, PHOENIX, AZ 85002-5046
(602) 542-0897
(602) 542-0102
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
186751
AHCCCS
AZ
01
—
1Z4231
HEALTH NET
AZ
01
—
AZ0727710
BLUECROSS/BLUESHIELD
AZ
Enumeration date
04/06/2007
Last updated
06/11/2021
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