Provider Demographics
NPI:1053053165
Name:FOUR CORNERS TESTING LLC
Entity Type:Organization
Organization Name:FOUR CORNERS TESTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-371-3336
Mailing Address - Street 1:14150 NE 20TH ST STE F1-282
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3700
Mailing Address - Country:US
Mailing Address - Phone:206-371-3336
Mailing Address - Fax:
Practice Address - Street 1:11625 RAINIER AVE S STE 102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98178-3983
Practice Address - Country:US
Practice Address - Phone:206-558-9577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-09
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center