02D2296697 CLIA NUMBER - DENALI PRIMARY CARE, LLC

Laboratory Demographics

  • CLIA Code: 02D2296697
  • Facility Name: DENALI PRIMARY CARE, LLC
  • Facility Address: 1919 LATHROP ST, STE 204
    FAIRBANKS, AK
    ZIP 99701
  • Facility Phone: 907 374-2637
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MANAL D. SHIHADEH
  • NPI Number: 1710664966
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 02D2296697
LAB Type Physician Office
Facility Name DENALI PRIMARY CARE, LLC
Street 1919 LATHROP ST, STE 204
City FAIRBANKS
State AK
ZIP 99701
Phone 907 374-2637
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2024
Certificate Expiration Date 1/3/2026
Facility Type Physician Office
Lab Director DR. MANAL D. SHIHADEH

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