Provider Demographics
NPI:1265789416
Name:PHOENIX TOXICOLOGY & LAB SERVICES
Entity type:Organization
Organization Name:PHOENIX TOXICOLOGY & LAB SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-678-5400
Mailing Address - Street 1:PO BOX 844679
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-4679
Mailing Address - Country:US
Mailing Address - Phone:602-678-5400
Mailing Address - Fax:602-678-5401
Practice Address - Street 1:2432 W PEORIA AVE
Practice Address - Street 2:SUITE 1064
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4726
Practice Address - Country:US
Practice Address - Phone:602-678-5400
Practice Address - Fax:602-678-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ822423Medicaid
AZZ158088Medicare PIN