MEDICARE: NORTHERN PACIFIC DIAGNOSTICS P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	38D1000455	OR

General Provider Information

NPI Number	:	1396837340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN PACIFIC DIAGNOSTICS P C

Provider Business Mailing Address
First Line	:	1208 BEALL LN
Second Line	:
City	:	CENTRAL POINT
State	:	OR
Zip	:	97502-1573
Country	:	US
Telephone Number	:	800-734-7486
Fax Number	:	877-772-9433

Provider Business Practice Location Address
First Line	:	2865 DAGGETT AVE
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1106
Country	:	US
Telephone Number	:	541-664-5151
Fax Number	:	541-664-5155

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIGUEL MONTES
Credential	:
Telephone Number	:	541-274-4049

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	12/02/2025

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