Basic Information
| Provider Information | |||||||||
| NPI: | 1023263647 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFIC PATHOLOGY ASSOCIATES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6930 | ||||||||
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| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972286930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035615350 | ||||||||
| FaxNumber: | 4198665453 | ||||||||
| Practice Location | |||||||||
| Address1: | 665 WINTER ST SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973013934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035615350 | ||||||||
| FaxNumber: | 4198665453 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2008 | ||||||||
| LastUpdateDate: | 07/05/2013 | ||||||||
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| AuthorizedOfficialLastName: | MCDONALD | ||||||||
| AuthorizedOfficialFirstName: | CLARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5035615350 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 38D1091741 | OR | N | Laboratories | Clinical Medical Laboratory | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.