Provider Demographics
NPI:1700521630
Name:TESIS LABS OF ARIZONA LLC
Entity Type:Organization
Organization Name:TESIS LABS OF ARIZONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUTEREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-818-7598
Mailing Address - Street 1:107 PROSPECT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SCHOHARIE
Mailing Address - State:NY
Mailing Address - Zip Code:12157-3204
Mailing Address - Country:US
Mailing Address - Phone:480-454-4594
Mailing Address - Fax:
Practice Address - Street 1:8125 N 86TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4310
Practice Address - Country:US
Practice Address - Phone:480-454-4594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory