02D0911413 CLIA NUMBER - MT SANFORD TRIBAL CONSORTIUM

Laboratory Demographics

CLIA Number: 02D0911413

Facility Name: MT SANFORD TRIBAL CONSORTIUM

Facility Address:
MILE 33 TOK CUT OFF HWY
GAKONA, AK
ZIP 99586
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Facility Phone Number: 907 822-5399

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1427104959

Taxonomy: 261QC1500X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	02D0911413
LAB Type	Community Clinic
Facility Name	MT SANFORD TRIBAL CONSORTIUM
Street	MILE 33 TOK CUT OFF HWY
City	GAKONA
State	AK
ZIP	99586
Phone	907 822-5399
CertificateType	4
CertificateEffectiveDate	11/13/2023
CertificateExpirationDate	11/12/2025
FacilityType	Waiver

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