Provider Demographics
NPI:1568882454
Name:OUS OREGON STATE UNIVERSITY
Entity Type:Organization
Organization Name:OUS OREGON STATE UNIVERSITY
Other - Org Name:STUDENT HEALTH SERVICES MEDICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DIRECTOR ADMIN SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-737-4619
Mailing Address - Street 1:108 SW MEMORIAL PL
Mailing Address - Street 2:OSU STUDENT HEALTH SERVICES LABORATORY
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97331-8667
Mailing Address - Country:US
Mailing Address - Phone:541-737-7548
Mailing Address - Fax:541-737-9336
Practice Address - Street 1:108 SW MEMORIAL PL
Practice Address - Street 2:OSU STUDENT HEALTH SERVICES LABORATORY
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8667
Practice Address - Country:US
Practice Address - Phone:541-737-7548
Practice Address - Fax:541-737-9336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OREGON UNIVERSITY SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR38D0856060291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory