Provider Demographics
NPI:1124353289
Name:UMPQUA REGIONAL MEDICAL CENTER DIAGNOSTICS
Entity type:Organization
Organization Name:UMPQUA REGIONAL MEDICAL CENTER DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-957-3079
Mailing Address - Street 1:123 PONDEROSA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-9812
Mailing Address - Country:US
Mailing Address - Phone:541-459-3500
Mailing Address - Fax:541-459-4040
Practice Address - Street 1:123 PONDEROSA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SUTHERLIN
Practice Address - State:OR
Practice Address - Zip Code:97479-9812
Practice Address - Country:US
Practice Address - Phone:541-459-3500
Practice Address - Fax:541-459-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory