Provider Demographics
NPI:1992978118
Name:COLUMBIA CLINICAL LABORATORY, INC
Entity type:Organization
Organization Name:COLUMBIA CLINICAL LABORATORY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-657-3329
Mailing Address - Street 1:15630 SE 90 AVE.
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9729
Mailing Address - Country:US
Mailing Address - Phone:503-657-3329
Mailing Address - Fax:503-210-7905
Practice Address - Street 1:15630 SE 90 AVE.
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9729
Practice Address - Country:US
Practice Address - Phone:503-657-3329
Practice Address - Fax:503-210-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16691261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORF10477Medicare UPIN
0000BKJDWMedicare PIN