Northwest Medical Diagnostic Laboratory

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

50D2098207 Issued in WA

Legal business name

NORTHWEST MEDICAL DIAGNOSTIC LABORATORY

Practice address

1003 Fir St
Longview, WA 98632-2526

Phone

(360) 442-4129

Fax

(360) 442-4130

NPI assigned

May 11, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carl Jerome Lian, MLT

Title

Ceo

Phone

(360) 442-4129

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454025600000",
    "number": "1457739559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 FIR ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "98632",
            "telephone_number": "360-442-4129",
            "fax_number": "360-442-4130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 FIR ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322526",
            "telephone_number": "360-442-4129",
            "fax_number": "360-442-4130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST MEDICAL DIAGNOSTIC LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-11",
        "last_updated": "2016-01-29",
        "status": "A",
        "authorized_official_last_name": "LIAN",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "JEROME",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-442-4129",
        "authorized_official_credential": "MLT"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WA",
            "license": "50D2098207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Longview, WA
• Providers in Longview, WA by specialty
• Clinical Medical Laboratory in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.