02D0641002 CLIA NUMBER - KODIAK AREA NATIVE ASSOCIATION KANA MAIN

Laboratory Demographics

CLIA Number: 02D0641002

Facility Name: KODIAK AREA NATIVE ASSOCIATION KANA MAIN

Facility Address:
3449 E REZANOF DRIVE
KODIAK, AK
ZIP 99615
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Facility Phone Number: 907 486-9847

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1801187471

Taxonomy: 261QC1500X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	02D0641002
LAB Type	Community Clinic
Facility Name	KODIAK AREA NATIVE ASSOCIATION KANA MAIN
Street	3449 E REZANOF DRIVE
City	KODIAK
State	AK
ZIP	99615
Phone	907 486-9847
CertificateType	4
CertificateEffectiveDate	11/2/2022
CertificateExpirationDate	11/1/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024