02D0897151 CLIA NUMBER - FAIRBANKS CLINIC

Laboratory Demographics

CLIA Number: 02D0897151

Facility Name: FAIRBANKS CLINIC

Facility Address:
1405 KELLUM STREET, STE 201
FAIRBANKS, AK
ZIP 99701
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Facility Phone Number: 907 452-1761

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1073636148

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	02D0897151
LAB Type	Physician Office
Facility Name	FAIRBANKS CLINIC
Street	1405 KELLUM STREET, STE 201
City	FAIRBANKS
State	AK
ZIP	99701
Phone	907 452-1761
CertificateType	3
CertificateEffectiveDate	9/28/2022
CertificateExpirationDate	9/27/2024
FacilityType	PPMP

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