05D0692143 CLIA NUMBER - WARNER MOUNTAIN INDIAN HEALTH CLINIC

Laboratory Demographics

  • CLIA Code: 05D0692143
  • Facility Name: WARNER MOUNTAIN INDIAN HEALTH CLINIC
  • Facility Address: 132 MEE THEE-UH ROAD
    FORT BIDWELL, CA
    ZIP 96112
  • Facility Phone: 530 279-6194
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: MARK C. GOODMAN MD
  • NPI Number: 1093931107
  • Taxonomy: 261QR1300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D0692143
LAB Type Community Clinic
Facility Name WARNER MOUNTAIN INDIAN HEALTH CLINIC
Street 132 MEE THEE-UH ROAD
City FORT BIDWELL
State CA
ZIP 96112
Phone 530 279-6194
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Community Clinic
Lab Director MARK C. GOODMAN 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