Provider Demographics
NPI:1518253996
Name:UNIVERSITY PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:UNIVERSITY PROFESSIONAL SERVICES
Other - Org Name:OHSU KNIGHT DIAGNOSTIC LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:WASDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-494-1471
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:MAILCODE: CR9-6 ATTN: KNIGHT DIAG LABS
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8744
Mailing Address - Fax:
Practice Address - Street 1:2525 SW 3RD AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-4901
Practice Address - Country:US
Practice Address - Phone:503-494-5400
Practice Address - Fax:503-494-6922
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OREGON HEALTH & SCIENCE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-23
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR38D0881787291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory