Provider Demographics
NPI:1326869579
Name:STUMPTOWN LAB SERVICES LLC
Entity type:Organization
Organization Name:STUMPTOWN LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-433-5334
Mailing Address - Street 1:1355 NW EVERETT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2655
Mailing Address - Country:US
Mailing Address - Phone:971-433-5334
Mailing Address - Fax:971-200-8669
Practice Address - Street 1:1355 NW EVERETT ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2655
Practice Address - Country:US
Practice Address - Phone:971-433-5334
Practice Address - Fax:971-200-8669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty