Healthcare Provider Details

I. General information

NPI: 1366033862
Provider Name (Legal Business Name): NEOGENOMICS LABORATORIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10560 NW GLENMORE WAY
PORTLAND OR
97229-4067
US

IV. Provider business mailing address

31 COLUMBIA
ALISO VIEJO CA
92656-1460
US

V. Phone/Fax

Practice location:
  • Phone: 866-776-5907
  • Fax: 888-443-4153
Mailing address:
  • Phone: 866-776-5907
  • Fax: 888-443-4153

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: KATHRYN BISOGNO MCKENZIE
Title or Position: CFO
Credential:
Phone: 239-768-0600