05D0683237 CLIA NUMBER - MERCY MT SHASTA COMMUNITY CLINIC

Laboratory Demographics

  • CLIA Code: 05D0683237
  • Facility Name: MERCY MT SHASTA COMMUNITY CLINIC
  • Facility Address: 912 PINE ST
    MOUNT SHASTA, CA
    ZIP 96067
  • Facility Phone: 530 926-5105
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: EDWARD P. LANE
  • NPI Number: 1568799500
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0683237
LAB Type Community Clinic
Facility Name MERCY MT SHASTA COMMUNITY CLINIC
Street 912 PINE ST
City MOUNT SHASTA
State CA
ZIP 96067
Phone 530 926-5105
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/10/2025
Certificate Expiration Date 10/9/2027
Facility Type Community Clinic
Lab Director EDWARD P. LANE

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