02D2013743 CLIA NUMBER - CENTRAL PENINSULA FAMILY PRACTICE-SOLDOTNA

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Laboratory Demographics

CLIA Number: 02D2013743

Facility Name: CENTRAL PENINSULA FAMILY PRACTICE-SOLDOTNA

Facility Address:
245 BINKLEY ST SUITE 101
SOLDOTNA, AK
ZIP 99669
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Facility Phone Number: 907 714-4111

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1831404805

Taxonomy: 282NR1301X - General Acute Care Hospital

CLIA Record

Field Name	Field Value
CLIA Number	02D2013743
LAB Type	Physician Office
Facility Name	CENTRAL PENINSULA FAMILY PRACTICE-SOLDOTNA
Street	245 BINKLEY ST SUITE 101
City	SOLDOTNA
State	AK
ZIP	99669
Phone	907 714-4111
CertificateType	4
CertificateEffectiveDate	9/23/2022
CertificateExpirationDate	9/22/2024
FacilityType	Waiver

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