Provider Demographics
NPI:1447397294
Name:COUNTY OF MENDOCINO
Entity Type:Organization
Organization Name:COUNTY OF MENDOCINO
Other - Org Name:LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:LAB MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-463-4145
Mailing Address - Street 1:501 LOW GAP RD
Mailing Address - Street 2:BASEMENT
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-3738
Mailing Address - Country:US
Mailing Address - Phone:707-463-4145
Mailing Address - Fax:
Practice Address - Street 1:501 LOW GAP RD
Practice Address - Street 2:BASEMENT
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-3738
Practice Address - Country:US
Practice Address - Phone:707-463-4145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB5859AFOtherPH MEDICAL LAB #