05D0612624 CLIA NUMBER - BAECHTEL CREEK MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 05D0612624

Facility Name: BAECHTEL CREEK MEDICAL CLINIC

Facility Address:
1245 SOUTH MAIN STREET
WILLITS, CA
ZIP 95490
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Facility Phone Number: 707 459-6861

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1568525400

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0612624
LAB Type	Physician Office
Facility Name	BAECHTEL CREEK MEDICAL CLINIC
Street	1245 SOUTH MAIN STREET
City	WILLITS
State	CA
ZIP	95490
Phone	707 459-6861
CertificateType	3
CertificateEffectiveDate	9/30/2023
CertificateExpirationDate	9/29/2025
FacilityType	PPMP

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