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General NPI Number Information
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NPI Number | 1518253996
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Entity Type | Organization
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Legal Business Name | UNIVERSITY PROFESSIONAL SERVICES
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 09/20/2017
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Provider Practice Location Address
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Address Line | 2525 SW 3RD AVE SUITE 350
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City | PORTLAND
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State | OR
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Zip | 97201-4901
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Country | US
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Telephone | 503-494-5400
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Fax | 503-494-6922
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Provider Business Mailing Address
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Address Line | 3181 SW SAM JACKSON PARK RD MAILCODE: CR9-6 ATTN: KNIGHT DIAG LABS
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone | 503-494-8744
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MR. MITCH WASDEN
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Credential |
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Telephone | 503-494-1471
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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 | 38D0881787
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License Number State | OR
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