Organization
CLINICAL LABORATORIES P S
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD W LONG M.D. (C.E.O.)
(509) 943-6060
Entity
Organization
Contact information
Practice address
750 SWIFT BLVD, SUITE 5, RICHLAND, WA 99352-3521
(509) 943-6060
(509) 946-0397
Mailing address
750 SWIFT BLVD, SUITE 5, RICHLAND, WA 99352-3521
(509) 943-6060
(509) 946-0397
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
MTS-0299
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0167509
DEPT OF LABOR & IND.
WA
01
—
191582400
DOL DEEOIC
WA
01
—
50D0640090
CLIA#
WA
01
—
7015621
DSHS ID#
WA
Enumeration date
01/22/2007
Last updated
04/12/2011
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