Provider Demographics
NPI:1043906985
Name:BASELINE LABORATORY SERVICES
Entity type:Organization
Organization Name:BASELINE LABORATORY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-414-0362
Mailing Address - Street 1:1744 E MCANDREWS RD STE D
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5576
Mailing Address - Country:US
Mailing Address - Phone:541-414-0362
Mailing Address - Fax:541-200-2269
Practice Address - Street 1:537 MURPHY RD STE B
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8187
Practice Address - Country:US
Practice Address - Phone:541-414-0362
Practice Address - Fax:541-200-2269
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BASELINE LABORATORY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-13
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500821822Medicaid
OR38D2275224OtherCLIA