Healthcare Provider Details

I. General information

NPI: 1700995966
Provider Name (Legal Business Name): MEDICAL CENTER LABORATORY, INC. PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S 12TH AVE
YAKIMA WA
98902-3142
US

IV. Provider business mailing address

401 S 12TH AVE
YAKIMA WA
98902-3142
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-1831
  • Fax:
Mailing address:
  • Phone: 509-248-1831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License NumberMTS-0302
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code246QC2700X
TaxonomyCytotechnology Specialist/Technologist
License NumberMTS-0302
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code246QH0600X
TaxonomyHistology Specialist/Technologist
License NumberMTS-0302
License Number StateWA

VIII. Authorized Official

Name: DR. JOHN W. ONSTAD
Title or Position: PRESIDENT/PARTNER
Credential: M.D.
Phone: 509-248-1831