| NPI | 1962657783 |
|---|---|
| Other Name | OUTPATIEN TREATMENT CTR |
| Entity Type | Organization |
| Authorized Contact | AZAM S KHAN Chief Administrative Officer 928-757-3636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: AZ 03D0534286) |
| Additional Taxonomies | 261QU0200X Clinic/Center Urgent Care (Licence: AZ OTC-0660) |
| 335V00000X Portable X-ray and/or Other Portable Diagnostic Imaging Supplier (Licence: AZ OTC-0660) | |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2018-06-04 |