Provider Demographics
NPI:1639162779
Name:KEMPTON & NELSON DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:KEMPTON & NELSON DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:CARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-964-4242
Mailing Address - Street 1:4852 E BASELINE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4627
Mailing Address - Country:US
Mailing Address - Phone:480-610-6400
Mailing Address - Fax:480-964-4455
Practice Address - Street 1:4852 E BASELINE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4627
Practice Address - Country:US
Practice Address - Phone:480-610-6400
Practice Address - Fax:480-964-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC5108293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ862872Medicaid
AZZ76943Medicare UPIN