Basic Information
| Provider Information | |||||||||
| NPI: | 1124353289 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UMPQUA REGIONAL MEDICAL CENTER DIAGNOSTICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 PONDEROSA DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SUTHERLIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974799812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414593500 | ||||||||
| FaxNumber: | 5414594040 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 PONDEROSA DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SUTHERLIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974799812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414593500 | ||||||||
| FaxNumber: | 5414594040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2009 | ||||||||
| LastUpdateDate: | 10/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | WARNER | ||||||||
| AuthorizedOfficialFirstName: | JAMIE | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5419573079 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.