Organization
INTRACELLULAR DIAGNOSTICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BURTON B SILVER PH.D (LABORATORY DIRECTOR)
(541) 245-3212
Entity
Organization
Contact information
Practice address
945 TOWN CENTRE DR, SUITE A, MEDFORD, OR 97504-6190
(541) 245-3212
Mailing address
945 TOWN CENTRE DR, SUITE A, MEDFORD, OR 97504-6190
(541) 245-3212
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
05D0643971
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0643971
CLIA NUMBER
CA
01
—
05D0643971
CLIA
OR
01
—
COS00004338
CA OUT OF STATE
OR
Enumeration date
01/25/2007
Last updated
06/11/2014
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