02D1002124 CLIA NUMBER - PROVIDENCE BREAKTHROUGH

Laboratory Demographics

  • CLIA Code: 02D1002124
  • Facility Name: PROVIDENCE BREAKTHROUGH
  • Facility Address: 3760 PIPER STREET SUITE 1108
    ANCHORAGE, AK
    ZIP 99508
  • Facility Phone: 907 562-7325
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: BRITNE DAWN PEDERSEN
  • NPI Number: 1265967137
  • Taxonomy: 261QR0207X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 02D1002124
LAB Type Other
Facility Name PROVIDENCE BREAKTHROUGH
Street 3760 PIPER STREET SUITE 1108
City ANCHORAGE
State AK
ZIP 99508
Phone 907 562-7325
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/29/2024
Certificate Expiration Date 7/28/2026
Facility Type Other
Lab Director BRITNE DAWN PEDERSEN

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This page was last updated on: 9/29/2025