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General NPI Number Information
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NPI Number | 1942354535
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Entity Type | Organization
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Legal Business Name | CLINICAL LABORATORIES P S
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 750 SWIFT BLVD SUITE 5
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City | RICHLAND
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State | WA
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Zip | 99352-3521
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Country | US
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Telephone | 509-943-6060
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Fax | 509-946-0397
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Provider Business Mailing Address
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Address Line | 750 SWIFT BLVD SUITE 5
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City | RICHLAND
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State | WA
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Zip | 99352-3521
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Country | US
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Telephone | 509-943-6060
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Fax | 509-946-0397
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. RICHARD W LONG
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Credential | M.D.
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Telephone | 509-943-6060
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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 | MTS-0299
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License Number State | WA
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