Provider Demographics
NPI:1306125778
Name:INTEGRATED LABS
Entity type:Organization
Organization Name:INTEGRATED LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DODIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NOLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-646-0858
Mailing Address - Street 1:302 E HERSEY ST STE 12
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1957
Mailing Address - Country:US
Mailing Address - Phone:541-646-0858
Mailing Address - Fax:541-488-7721
Practice Address - Street 1:24076 SE STARK ST STE 320
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3386
Practice Address - Country:US
Practice Address - Phone:503-512-1212
Practice Address - Fax:503-512-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory