Healthcare Provider Details

I. General information

NPI: 1730585449
Provider Name (Legal Business Name): INTERPATH LABORATORY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 SW PERKINS AVE
PENDLETON OR
97801-4302
US

IV. Provider business mailing address

2460 SW PERKINS AVE
PENDLETON OR
97801-4302
US

V. Phone/Fax

Practice location:
  • Phone: 254-276-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number291U00000X
License Number StateOR

VIII. Authorized Official

Name: MR. THOMAS KENNEDY
Title or Position: PRESIDENT
Credential:
Phone: 541-276-6700