MEDICARE: LABRIX CLINICAL SERVICES, INC

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

General Provider Information

NPI Number	:	1902019342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABRIX CLINICAL SERVICES, INC

Provider Business Mailing Address
First Line	:	619 MADISON ST STE 100
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-2354
Country	:	US
Telephone Number	:	503-656-9596
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 MADISON ST STE 100
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-2354
Country	:	US
Telephone Number	:	503-656-9596
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JAY MEAD
Credential	:	M.D.
Telephone Number	:	503-656-9596

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	08/22/2020

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