02D2026103 CLIA NUMBER - PEACEHEALTH KETCHIKAN MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 02D2026103
  • Facility Name: PEACEHEALTH KETCHIKAN MEDICAL CENTER
  • Facility Address: 3100 TONGASS AVE ATTN KMOB OBGYN
    KETCHIKAN, AK
    ZIP 99901
  • Facility Phone: 907 228-7688
  • Facility Type: Rural Health Clinic
  • Facility Type: Microscopy
  • Lab Director: DR. NICOLE A. MORIN
  • NPI Number: 1235556846
  • Taxonomy: 208600000X - Surgery

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CLIA Record

Field Name Field Value
CLIA Number 02D2026103
LAB Type Rural Health Clinic
Facility Name PEACEHEALTH KETCHIKAN MEDICAL CENTER
Street 3100 TONGASS AVE ATTN KMOB OBGYN
City KETCHIKAN
State AK
ZIP 99901
Phone 907 228-7688
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/23/2025
Certificate Expiration Date 6/22/2027
Facility Type Rural Health Clinic
Lab Director DR. NICOLE A. MORIN

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