05D0613049 CLIA NUMBER - SOUTHERN TRINITY HEALTH SERVICES INC

Laboratory Demographics

  • CLIA Code: 05D0613049
  • Facility Name: SOUTHERN TRINITY HEALTH SERVICES INC
  • Facility Address: 321 VAN DUZEN RD
    MAD RIVER, CA
    ZIP 95552
  • Facility Phone: 707 764-5617
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: FRED WAKIL, MD
  • NPI Number: 1619236023
  • Taxonomy: 261QF0400X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D0613049
LAB Type Federally Qualified Health Center
Facility Name SOUTHERN TRINITY HEALTH SERVICES INC
Street 321 VAN DUZEN RD
City MAD RIVER
State CA
ZIP 95552
Phone 707 764-5617
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/16/2024
Certificate Expiration Date 11/15/2026
Facility Type Federally Qualified Health Center
Lab Director FRED WAKIL, MD

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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