Provider Demographics
NPI:1093267023
Name:ADVANCE BIOMETRIX, LLC
Entity Type:Organization
Organization Name:ADVANCE BIOMETRIX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIBOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-000-0000
Mailing Address - Street 1:16869 SW 65TH AVE STE 455
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:800-000-0000
Mailing Address - Fax:
Practice Address - Street 1:2344 WALSH AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-1327
Practice Address - Country:US
Practice Address - Phone:800-000-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory