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General NPI Number Information
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NPI Number | 1154454718
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Entity Type | Organization
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Legal Business Name | PORTLAND TISSUE PROCESSING LABORATORY, INC.
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 5012 NE 42ND AVE
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City | PORTLAND
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State | OR
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Zip | 97218-1504
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Country | US
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Telephone | 503-287-7721
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Fax | 503-287-7728
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Provider Business Mailing Address
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Address Line | 5012 NE 42ND AVE
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City | PORTLAND
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State | OR
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Zip | 97218-1504
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Country | US
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Telephone | 503-287-7721
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Fax | 503-287-7728
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | JANE PALOMO ROBERTSON
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Credential |
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Telephone | 503-287-7721
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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 | 38D1063205
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License Number State | OR
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