05D0615060 CLIA NUMBER - BARTON FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 05D0615060

Facility Name: BARTON FAMILY MEDICINE

Facility Address:
1090 THIRD STREET, STE 1
SOUTH LAKE TAHOE, CA
ZIP 96150
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Facility Phone Number: 530 543-5660

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1154631703

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0615060
LAB Type	Physician Office
Facility Name	BARTON FAMILY MEDICINE
Street	1090 THIRD STREET, STE 1
City	SOUTH LAKE TAHOE
State	CA
ZIP	96150
Phone	530 543-5660
CertificateType	3
CertificateEffectiveDate	1/22/2023
CertificateExpirationDate	1/21/2025
FacilityType	PPMP

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