05D0901250 CLIA NUMBER - SHINGLE SPRINGS TRIBAL HEALTH PROGRAM

Laboratory Demographics

  • CLIA Code: 05D0901250
  • Facility Name: SHINGLE SPRINGS TRIBAL HEALTH PROGRAM
  • Facility Address: 5168 HONPIE RD SHINGLE SPRINGS TRIBAL HEALTH PROGRAM 5TH FLOOR
    PLACERVILLE, CA
    ZIP 95667
  • Facility Phone: 530 387-4975
  • Facility Type: Other - TRIBAL HEALTH PROGRAM
  • Facility Type: Microscopy
  • Lab Director: WAYNE DANIEL
  • NPI Number: 1245356674
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0901250
LAB Type Other - TRIBAL HEALTH PROGRAM
Facility Name SHINGLE SPRINGS TRIBAL HEALTH PROGRAM
Street 5168 HONPIE RD SHINGLE SPRINGS TRIBAL HEALTH PROGRAM 5TH FLOOR
City PLACERVILLE
State CA
ZIP 95667
Phone 530 387-4975
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 6/17/2024
Certificate Expiration Date 6/16/2026
Facility Type Other - TRIBAL HEALTH PROGRAM
Lab Director WAYNE DANIEL

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