Organization
VISTA PATHOLOGY LABORATORY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHARI L BRITE (ADMINISTRATOR)
(541) 770-4559
Entity
Organization
Contact information
Practice address
94220 4TH ST, GOLD BEACH, OR 97444-7756
(800) 445-8085
Mailing address
PO BOX 1000, MEDFORD, OR 97501-0071
(541) 770-4559
(541) 770-4511
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38D2036013
CLIA
OR
Enumeration date
03/07/2012
Last updated
04/18/2012
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