1013973866 NPI number — CARIS MPI, INC.

Table of content: (NPI 1013973866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013973866 NPI number — CARIS MPI, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARIS MPI, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CARIS LIFE SCIENCES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013973866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 W JOHN CARPENTER FWY STE 800
Provider Second Line Business Mailing Address:
C/O KELLY BERMAN
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75039-2520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-979-8669
Provider Business Mailing Address Fax Number:
480-522-3506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4610 SOUTH 44TH PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85040-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-979-8669
Provider Business Practice Location Address Fax Number:
480-522-3506
Provider Enumeration Date:
04/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POWER
Authorized Official First Name:
LUKE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO AND CAO AND TREASURER
Authorized Official Telephone Number:
214-294-5568

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  03D1019490 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 117954200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".