Provider Demographics
NPI:1447925193
Name:JW BARKLINGTON ESQ LLC
Entity type:Organization
Organization Name:JW BARKLINGTON ESQ LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:480-744-1950
Mailing Address - Street 1:3834 E EQUESTRIAN TRL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3009
Mailing Address - Country:US
Mailing Address - Phone:480-744-1950
Mailing Address - Fax:
Practice Address - Street 1:12020 S WARNER ELLIOT LOOP STE 124
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-2717
Practice Address - Country:US
Practice Address - Phone:480-744-1950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-14
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ123857Medicaid