Provider Demographics
NPI:1174847727
Name:KA SERVICES INC
Entity Type:Organization
Organization Name:KA SERVICES INC
Other - Org Name:LEGACY BRIDGEVIEW MEDICAL LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-575-6916
Mailing Address - Street 1:818 SW 3RD AVE
Mailing Address - Street 2:STE 188
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-2405
Mailing Address - Country:US
Mailing Address - Phone:503-575-6916
Mailing Address - Fax:
Practice Address - Street 1:818 SW 3RD AVE
Practice Address - Street 2:STE 188
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2405
Practice Address - Country:US
Practice Address - Phone:503-575-6916
Practice Address - Fax:866-243-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR38D0673412291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory