Provider Demographics
NPI:1053841817
Name:COLUMBIA DIAGNOSTIC LAB, INC.
Entity Type:Organization
Organization Name:COLUMBIA DIAGNOSTIC LAB, INC.
Other - Org Name:COLUMBIA DX LAB, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER AND LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-420-6386
Mailing Address - Street 1:85103 N YAKIMA RIVER DR
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-6189
Mailing Address - Country:US
Mailing Address - Phone:509-420-6386
Mailing Address - Fax:
Practice Address - Street 1:507 S WASHINGTON ST STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2604
Practice Address - Country:US
Practice Address - Phone:509-420-6386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA50D2131654291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory