02D0641146 CLIA NUMBER - MAT-SU REGIONAL OUTPATIENT CENTER

Laboratory Demographics

CLIA Number: 02D0641146

Facility Name: MAT-SU REGIONAL OUTPATIENT CENTER

Facility Address:
950 E BOGARD RD
WASILLA, AK
ZIP 99654
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Facility Phone Number: 907 376-5028

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Accreditation

NPI Number: 1184725210

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	02D0641146
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	MAT-SU REGIONAL OUTPATIENT CENTER
Street	950 E BOGARD RD
City	WASILLA
State	AK
ZIP	99654
Phone	907 376-5028
CertificateType	1
CertificateEffectiveDate	1/3/2023
CertificateExpirationDate	1/2/2025
FacilityType	Accreditation

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