Organization
THE PORTLAND CLINIC LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DICK CLARK (CEO)
(503) 221-0161
Entity
Organization
Contact information
Practice address
800 SW 13TH AVE, PORTLAND, OR 97205
(503) 221-0161
(503) 274-1697
Mailing address
800 SW 13TH AVE, PORTLAND, OR 97205
(503) 221-0161
(503) 274-1697
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38D06235
CLIA
OR
Enumeration date
02/28/2007
Last updated
10/26/2020
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