Arizona Independent Diagnostic Testing Facility PLLC
NPI 1205422367ActiveOrganization· Physiological Laboratory· Phoenix, AZ
Physiological Laboratory in Phoenix, Arizona, registered in NPPES in December 2020. The authorized official on file is Jeff Brouwer, Managing Member.
Overview
| NPI | 1205422367 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 14, 2020 |
| Last updated in NPPES | Dec 15, 2020 |
| Certified by provider | Dec 15, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physiological Laboratory Primary | 293D00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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