Provider Demographics
NPI:1013973866
Name:CARIS MPI, INC.
Entity type:Organization
Organization Name:CARIS MPI, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO AND CAO AND TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:POWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-294-5568
Mailing Address - Street 1:750 W JOHN CARPENTER FWY STE 800
Mailing Address - Street 2:C/O KELLY BERMAN
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2520
Mailing Address - Country:US
Mailing Address - Phone:888-979-8669
Mailing Address - Fax:480-522-3506
Practice Address - Street 1:4610 SOUTH 44TH PLACE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-4010
Practice Address - Country:US
Practice Address - Phone:888-979-8669
Practice Address - Fax:480-522-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03D1019490291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ100114Medicare PIN