Provider Demographics
NPI:1942354535
Name:CLINICAL LABORATORIES P S
Entity type:Organization
Organization Name:CLINICAL LABORATORIES P S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-943-6060
Mailing Address - Street 1:750 SWIFT BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3521
Mailing Address - Country:US
Mailing Address - Phone:509-943-6060
Mailing Address - Fax:509-946-0397
Practice Address - Street 1:750 SWIFT BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3521
Practice Address - Country:US
Practice Address - Phone:509-943-6060
Practice Address - Fax:509-946-0397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMTS-0299291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0167509OtherDEPT OF LABOR & IND.
WA191582400OtherDOL DEEOIC
WA50D0640090OtherCLIA#
WA7015621OtherDSHS ID#
WA50D0640090OtherCLIA#
WA191582400OtherDOL DEEOIC