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General NPI Number Information
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NPI Number | 1053841817
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Entity Type | Organization
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Legal Business Name | COLUMBIA DIAGNOSTIC LAB, INC.
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 06/14/2017
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Provider Practice Location Address
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Address Line | 507 S WASHINGTON ST STE 101
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City | SPOKANE
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State | WA
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Zip | 99204-2604
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Country | US
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Telephone | 509-420-6386
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Fax |
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Provider Business Mailing Address
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Address Line | 85103 N YAKIMA RIVER DR
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City | WEST RICHLAND
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State | WA
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Zip | 99353-6189
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Country | US
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Telephone | 509-420-6386
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Fax |
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Authorized Official
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Title or Position | OWNER AND LABORATORY DIRECTOR
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Name | DR. RICHARD C BARRY
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Credential | PHD
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Telephone | 509-420-6386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 50D2131654
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License Number State | WA
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