Provider Demographics
NPI:1275647851
Name:AMDX, LTD
Entity Type:Organization
Organization Name:AMDX, LTD
Other - Org Name:AMERICAN MEDICAL DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEHLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-424-4450
Mailing Address - Street 1:2423 W DUNLAP AVE
Mailing Address - Street 2:#175
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5818
Mailing Address - Country:US
Mailing Address - Phone:602-424-4450
Mailing Address - Fax:602-424-4451
Practice Address - Street 1:2423 W DUNLAP AVE
Practice Address - Street 2:#175
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5818
Practice Address - Country:US
Practice Address - Phone:602-424-4450
Practice Address - Fax:602-424-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC4006174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ089896Medicaid
AZ089896Medicaid