03D2111795 CLIA NUMBER - Bradshaw Mountain Family Medicine LLC

Laboratory Demographics

CLIA Number: 03D2111795

Facility Name: Bradshaw Mountain Family Medicine LLC

Facility Address:
20175 E Stagecoach Trail, Ste
Mayer, AZ
ZIP 86333
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Facility Phone Number: (928) 710-1971

Facility Type: OTHER

Certificate Type: Waiver

NPI Number: 1902262272

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name Field Value
CLIA Number 03D2111795
LAB Type OTHER
Facility Name Bradshaw Mountain Family Medicine LLC
Street 20175 E Stagecoach Trail, Ste
City Mayer
State AZ
ZIP 86333
Phone (928) 710-1971

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This page was last updated on: 4/7/2021