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NPI Code Detail

MEDICARE: PATHOLOGY ASSOCIATES MEDICAL LABORATORIES, LLC

MEDICARE: PATHOLOGY ASSOCIATES MEDICAL LABORATORIES, LLC
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
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1578892782
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATHOLOGY ASSOCIATES MEDICAL LABORATORIES, LLC
Provider Business Mailing Address
First Line : PO BOX 2720
Second Line :
City : SPOKANE
State : WA
Zip : 99220-4002
Country : US
Telephone Number : 509-755-8600
Fax Number :
Provider Business Practice Location Address
First Line : 8935 SE POWELL BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97266-1938
Country : US
Telephone Number : 503-772-4335
Fax Number :
Authorized Official
Title or Position : CFO
Name : KURT ROGERS
Credential :
Telephone Number : 509-755-8903
Provider Enumeration Date : 12/17/2009
Last Update Date : 12/17/2009

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