Provider Demographics
NPI:1699224121
Name:COTTONWOOD DIAGNOSTICS LLP
Entity Type:Organization
Organization Name:COTTONWOOD DIAGNOSTICS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MURANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-201-1763
Mailing Address - Street 1:12351 S GATEWAY PARK PL
Mailing Address - Street 2:SUITE D-700
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9581
Mailing Address - Country:US
Mailing Address - Phone:801-201-1763
Mailing Address - Fax:801-683-9907
Practice Address - Street 1:12351 S GATEWAY PARK PL
Practice Address - Street 2:SUITE D-600
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9581
Practice Address - Country:US
Practice Address - Phone:801-201-1763
Practice Address - Fax:801-683-9907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
46D2118660OtherCLIA
027544OtherCOLA