Organization
MEDICAL DIAGNOSTIC LABORATORY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY PFEIFFER (BOOKKEEPER)
(360) 542-3232
Entity
Organization
Contact information
Practice address
409 ELEANOR LANE, BUILDING B, MOUNT VERNON, WA 98273
(360) 542-3232
(360) 424-6326
Mailing address
1500 E COLLEGE WAY, SUITE A, PMB 276, MOUNT VERNON, WA 98273-5637
(360) 542-3232
(360) 424-6326
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
MTS-4979
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MTS-4979
STATE LICENSE
WA
Enumeration date
12/11/2006
Last updated
08/22/2020
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