Provider Demographics
NPI:1508520495
Name:EMG DIAGNOSTIC TESTING SERVICES LLC
Entity Type:Organization
Organization Name:EMG DIAGNOSTIC TESTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-235-9785
Mailing Address - Street 1:1244 S SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4485
Mailing Address - Country:US
Mailing Address - Phone:928-235-9785
Mailing Address - Fax:
Practice Address - Street 1:1244 S SUNSET DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4485
Practice Address - Country:US
Practice Address - Phone:928-750-2635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No291U00000XLaboratoriesClinical Medical Laboratory