02D1069483 CLIA NUMBER - CENTRAL PENINSULA DIABETES CENTER

Laboratory Demographics

  • CLIA Code: 02D1069483
  • Facility Name: CENTRAL PENINSULA DIABETES CENTER
  • Facility Address: 209 W KATMAI AVENUE
    SOLDOTNA, AK
    ZIP 99669
  • Facility Phone: 907 714-4726
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANNA A. BOUTWELL
  • NPI Number: 1013791227
  • Taxonomy: 207RE0101X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 02D1069483
LAB Type Physician Office
Facility Name CENTRAL PENINSULA DIABETES CENTER
Street 209 W KATMAI AVENUE
City SOLDOTNA
State AK
ZIP 99669
Phone 907 714-4726
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/23/2023
Certificate Expiration Date 9/22/2025
Facility Type Physician Office
Lab Director ANNA A. BOUTWELL

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This page was last updated on: 3/20/2025