Provider Demographics
NPI:1396202602
Name:BEECHTREE DIAGNOSTICS LLP
Entity Type:Organization
Organization Name:BEECHTREE DIAGNOSTICS LLP
Other - Org Name:BEECHTREE DIAGNOSTICS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SEAMAN-HYATT
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:801-893-2773
Mailing Address - Street 1:PO BOX 35146
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5146
Mailing Address - Country:US
Mailing Address - Phone:801-893-2773
Mailing Address - Fax:801-683-9907
Practice Address - Street 1:41818 N VENTURE DR STE 150
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3190
Practice Address - Country:US
Practice Address - Phone:602-881-7810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEECHTREE DIAGNOSTICS LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT46D2103212OtherCLIA