02D2102681 CLIA NUMBER - VITAE INTEGRATIVE MEDICAL CENTER

Laboratory Demographics

CLIA Number: 02D2102681

Facility Name: VITAE INTEGRATIVE MEDICAL CENTER

Facility Address:
800 CORDOVA ST
ANCHORAGE, AK
ZIP 99501
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Facility Phone Number: 907 441-5568

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1760852388

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	02D2102681
LAB Type	Practitioner Other
Facility Name	VITAE INTEGRATIVE MEDICAL CENTER
Street	800 CORDOVA ST
City	ANCHORAGE
State	AK
ZIP	99501
Phone	907 441-5568
CertificateType	4
CertificateEffectiveDate	9/28/2023
CertificateExpirationDate	9/27/2025
FacilityType	Waiver

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