Provider Demographics
NPI:1427449420
Name:ORION HEALTHCORP
Entity type:Organization
Organization Name:ORION HEALTHCORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIADICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-389-1975
Mailing Address - Street 1:PO BOX 52505
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85072-2505
Mailing Address - Country:US
Mailing Address - Phone:480-389-1975
Mailing Address - Fax:
Practice Address - Street 1:297 KINGSBURY GRADE
Practice Address - Street 2:STE 100
Practice Address - City:STATELINE
Practice Address - State:NV
Practice Address - Zip Code:89449-9804
Practice Address - Country:US
Practice Address - Phone:480-389-8197
Practice Address - Fax:480-393-7521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory