02D0970564 CLIA NUMBER - WASILLA MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 02D0970564

Facility Name: WASILLA MEDICAL CLINIC

Facility Address:
1700 E PARKS HWY #200
WASILLA, AK
ZIP 99654
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Facility Phone Number: 907 373-6055

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1316015480

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	02D0970564
LAB Type	Physician Office
Facility Name	WASILLA MEDICAL CLINIC
Street	1700 E PARKS HWY #200
City	WASILLA
State	AK
ZIP	99654
Phone	907 373-6055
CertificateType	3
CertificateEffectiveDate	2/17/2024
CertificateExpirationDate	2/16/2026
FacilityType	PPMP

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