Basic Information
| Provider Information | |||||||||
| NPI: | 1275713778 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEMORIAL PHYSICIANS, PLLC | ||||||||
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| OtherOrganizationName: | MEMORIAL PHYSICIANS LABORATORY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3800 SUMMITVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989022715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092495066 | ||||||||
| FaxNumber: | 5092495042 | ||||||||
| Practice Location | |||||||||
| Address1: | 504 N 40TH AVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989084311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092483263 | ||||||||
| FaxNumber: | 5092252702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2007 | ||||||||
| LastUpdateDate: | 09/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | REED | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5092487849 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 50D1062355 | WA | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.