Basic Information
| Provider Information | |||||||||
| NPI: | 1154679363 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARONDELET HEALTH NETWORK | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHN REFERENCE LAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2202 N FORBES BLVD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857451412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208727700 | ||||||||
| FaxNumber: | 5208727508 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 N WILMOT RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857112602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5808733000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2012 | ||||||||
| LastUpdateDate: | 08/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | STRAUSS | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5208727700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | H0099 | AZ | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.