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General NPI Number Information
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NPI Number | 1497428379
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Entity Type | Organization
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Legal Business Name | SAVAGE CLASSY INC
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 6464 SW BORLAND RD STE C5
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City | TUALATIN
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State | OR
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Zip | 97062-8856
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Country | US
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Telephone | 503-878-5412
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Fax | 888-972-9515
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Provider Business Mailing Address
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Address Line | 6464 SW BORLAND RD STE C5
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City | TUALATIN
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State | OR
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Zip | 97062-8856
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Country | US
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Telephone | 503-878-5412
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Fax |
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Authorized Official
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Title or Position | LABORTATORY DIRECTOR
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Name | DR. HEATHER DRYDEN
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Credential | MD
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Telephone | 503-878-5412
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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 |
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License Number State |
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