Provider Demographics
NPI:1578972014
Name:COLMED LABORATORIES & RADIOLOGY
Entity Type:Organization
Organization Name:COLMED LABORATORIES & RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-317-6103
Mailing Address - Street 1:1724 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-7620
Mailing Address - Country:US
Mailing Address - Phone:602-317-6103
Mailing Address - Fax:480-718-8396
Practice Address - Street 1:2100 N HWY 360 STE 207B
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1010
Practice Address - Country:US
Practice Address - Phone:602-317-6103
Practice Address - Fax:480-718-8396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier