Provider Demographics
NPI:1669808853
Name:LAB EXPRESS PORTLAND INC
Entity type:Organization
Organization Name:LAB EXPRESS PORTLAND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:VILLAFANE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:503-747-7427
Mailing Address - Street 1:10445 SW CANYON RD STE 113
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1967
Mailing Address - Country:US
Mailing Address - Phone:503-747-7427
Mailing Address - Fax:503-747-7698
Practice Address - Street 1:10445 SW CANYON RD STE 113
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1967
Practice Address - Country:US
Practice Address - Phone:503-747-7427
Practice Address - Fax:503-747-7698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory