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NPI Code Detail

MEDICARE: TRI-CITIES LABORATORY LLC

MEDICARE: TRI-CITIES LABORATORY 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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
150D2108309OTHERCLIA

General Provider Information

NPI Number : 1689156556
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRI-CITIES LABORATORY LLC
Provider Business Mailing Address
First Line : PO BOX 2688
Second Line :
City : SPOKANE
State : WA
Zip : 99220-2688
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6710 W OKANOGAN PL RM
Second Line :
City : KENNEWICK
State : WA
Zip : 99336-8001
Country : US
Telephone Number : 509-942-2528
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : KIMBERLY T WILLIAMS
Credential :
Telephone Number : 800-222-7566
Provider Enumeration Date : 09/06/2018
Last Update Date : 09/06/2018

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Directions to “TRI-CITIES LABORATORY LLC ” Practice Location

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