Provider Demographics
NPI:1306455209
Name:ROSE CITY LABORATORIES, LLC
Entity type:Organization
Organization Name:ROSE CITY LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-307-0096
Mailing Address - Street 1:7200 SE JOHNSON CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-9332
Mailing Address - Country:US
Mailing Address - Phone:503-307-0096
Mailing Address - Fax:
Practice Address - Street 1:7200 SE JOHNSON CREEK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-9332
Practice Address - Country:US
Practice Address - Phone:503-307-0096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Multi-Specialty
No293D00000XLaboratoriesPhysiological Laboratory