Provider Demographics
NPI:1902576408
Name:MEND TESTING
Entity Type:Organization
Organization Name:MEND TESTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF REVENUE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:623-385-2288
Mailing Address - Street 1:4045 W BELL RD APT 1008
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-2735
Mailing Address - Country:US
Mailing Address - Phone:623-385-2288
Mailing Address - Fax:
Practice Address - Street 1:1978 E SUNBURST LN
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1761
Practice Address - Country:US
Practice Address - Phone:623-385-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center