02D2136079 CLIA NUMBER - KODIAK AREA NATIVE ASSOCIATION MILL BAY HEALTH CENTER

Laboratory Demographics

CLIA Number: 02D2136079

Facility Name: KODIAK AREA NATIVE ASSOCIATION MILL BAY HEALTH CENTER

Facility Address:
2414 MILL BAY ROAD
KODIAK, AK
ZIP 99615
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Facility Phone Number: 907 486-9800

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1205883907

Taxonomy: 261QD0000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	02D2136079
LAB Type	Federally Qualified Health Center
Facility Name	KODIAK AREA NATIVE ASSOCIATION MILL BAY HEALTH CENTER
Street	2414 MILL BAY ROAD
City	KODIAK
State	AK
ZIP	99615
Phone	907 486-9800
CertificateType	3
CertificateEffectiveDate	9/1/2023
CertificateExpirationDate	8/31/2025
FacilityType	PPMP

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