Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Bradshaw Mountain Diagnostic Laboratory Inc

Organization Clinical Medical Laboratory · NPI 1003802075

Bradshaw Mountain Diagnostic Laboratory Inc is a Clinical Medical Laboratory in Prescott, Arizona. Licensed in Arizona. Registered with an NPI since 2005.

Licensed in
AZ
In the registry since
2005
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

990 Willow Creek Rd
Prescott, AZ 86301-1640
Phone: (928) 778-7823
Fax: (928) 778-9419
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Medical Laboratory (primary) Taxonomy 291U00000X (AZ)

Record details

NPI number1003802075
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tom Fellows — President · (928) 778-7823
NPI enumeratedSeptember 23, 2005
Last updated in NPPESAugust 22, 2020
Mailing address990 Willow Creek Rd, Prescott, AZ 86301-1640

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