Provider Demographics
NPI:1386190718
Name:MONOLITH DIAGNOSTICS, PC
Entity Type:Organization
Organization Name:MONOLITH DIAGNOSTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SWAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-263-3706
Mailing Address - Street 1:PO BOX 6024
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86402-6024
Mailing Address - Country:US
Mailing Address - Phone:928-263-3706
Mailing Address - Fax:928-263-3604
Practice Address - Street 1:1740 SYCAMORE AVE
Practice Address - Street 2:STE. C
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-0942
Practice Address - Country:US
Practice Address - Phone:928-263-3706
Practice Address - Fax:928-263-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47589207ZP0101X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ220494Medicaid