Provider Demographics
NPI:1891252698
Name:NEGAWNEE ENTERPRISES
Entity Type:Organization
Organization Name:NEGAWNEE ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:LAB DIRECTOR
Authorized Official - Phone:520-800-9235
Mailing Address - Street 1:7130 E RIVER CANYON RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-2110
Mailing Address - Country:US
Mailing Address - Phone:520-800-9235
Mailing Address - Fax:520-230-8901
Practice Address - Street 1:6401 S COUNTRY CLUB RD STE 105
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-5909
Practice Address - Country:US
Practice Address - Phone:520-800-9235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory