05D0890381 CLIA NUMBER - MULE CREEK STATE PRISON

Laboratory Demographics

  • CLIA Code: 05D0890381
  • Facility Name: MULE CREEK STATE PRISON
  • Facility Address: 4001 HIGHWAY 104
    IONE, CA
    ZIP 95640
  • Facility Phone: 209 781-6372
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: DR. WESLEY VAUGHN
  • NPI Number: 1730583311
  • Taxonomy: 302F00000X - Exclusive Provider Organization

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CLIA Record

Field Name Field Value
CLIA Number 05D0890381
LAB Type Prison
Facility Name MULE CREEK STATE PRISON
Street 4001 HIGHWAY 104
City IONE
State CA
ZIP 95640
Phone 209 781-6372
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/17/2024
Certificate Expiration Date 8/16/2026
Facility Type Prison
Lab Director DR. WESLEY VAUGHN

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