02D0934737 CLIA NUMBER - KETCHIKAN INDIAN COMMUNITY TRIBAL HEALTH CLINIC

Laboratory Demographics

CLIA Number: 02D0934737

Facility Name: KETCHIKAN INDIAN COMMUNITY TRIBAL HEALTH CLINIC

Facility Address:
2960 TONGASS AVE ATTN LAB
KETCHIKAN, AK
ZIP 99901
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Facility Phone Number: 907 228-9201

Facility Type: Federally Qualified Health Center

Certificate Type: Accreditation

NPI Number: 1801437090

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	02D0934737
LAB Type	Federally Qualified Health Center
Facility Name	KETCHIKAN INDIAN COMMUNITY TRIBAL HEALTH CLINIC
Street	2960 TONGASS AVE ATTN LAB
City	KETCHIKAN
State	AK
ZIP	99901
Phone	907 228-9201
CertificateType	1
CertificateEffectiveDate	10/21/2022
CertificateExpirationDate	10/20/2024
FacilityType	Accreditation

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