Provider Demographics
NPI:1972637817
Name:HEMEX LABORATORIES LLC
Entity Type:Organization
Organization Name:HEMEX LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:602-997-9161
Mailing Address - Street 1:2505 W BERYL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-1641
Mailing Address - Country:US
Mailing Address - Phone:602-997-9161
Mailing Address - Fax:602-997-1406
Practice Address - Street 1:2505 W BERYL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-1641
Practice Address - Country:US
Practice Address - Phone:602-997-9161
Practice Address - Fax:602-997-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2719101OtherCAP LAP #
AZ3L0008134Medicare ID - Type Unspecified