02D1043809 CLIA NUMBER - KENAI HEALTH CLINIC

Laboratory Demographics

CLIA Number: 02D1043809

Facility Name: KENAI HEALTH CLINIC

Facility Address:
630 BARNACLE WAY SUITE B
KENAI, AK
ZIP 99611
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Facility Phone Number: 907 714-4547

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Waiver

NPI Number: 1659825776

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	02D1043809
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	KENAI HEALTH CLINIC
Street	630 BARNACLE WAY SUITE B
City	KENAI
State	AK
ZIP	99611
Phone	907 714-4547
CertificateType	4
CertificateEffectiveDate	8/3/2023
CertificateExpirationDate	8/2/2025
FacilityType	Waiver

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