02D0985615 CLIA NUMBER - KODIAK ISLAND AMBULATORY CARE CLINIC

Laboratory Demographics

CLIA Number: 02D0985615

Facility Name: KODIAK ISLAND AMBULATORY CARE CLINIC

Facility Address:
202 CENTER STREET SUITE 102
KODIAK, AK
ZIP 99615
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Facility Phone Number: 907 486-6188

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1366596504

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	02D0985615
LAB Type	Physician Office
Facility Name	KODIAK ISLAND AMBULATORY CARE CLINIC
Street	202 CENTER STREET SUITE 102
City	KODIAK
State	AK
ZIP	99615
Phone	907 486-6188
CertificateType	3
CertificateEffectiveDate	4/24/2023
CertificateExpirationDate	4/23/2025
FacilityType	PPMP

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