Healthcare Provider Details

I. General information

NPI: 1043906985
Provider Name (Legal Business Name): BASELINE LABORATORY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 08/22/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 MURPHY RD STE B
MEDFORD OR
97504-8187
US

IV. Provider business mailing address

1744 E MCANDREWS RD STE D
MEDFORD OR
97504-5576
US

V. Phone/Fax

Practice location:
  • Phone: 541-414-0362
  • Fax: 541-200-2269
Mailing address:
  • Phone: 541-414-0362
  • Fax: 541-200-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MARGARITA R MOORE
Title or Position: CREDENTIALING
Credential:
Phone: 541-414-0362