05D0963207 CLIA NUMBER - FAMILY MEDICAL CENTER - COPPEROPOLIS

Laboratory Demographics

  • CLIA Code: 05D0963207
  • Facility Name: FAMILY MEDICAL CENTER - COPPEROPOLIS
  • Facility Address: 430 SAWMILL CREEK
    COPPEROPOLIS, CA
    ZIP 95228
  • Facility Phone: 209 754-2520
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: DEAN M. KELAITA MD
  • NPI Number: 1942362561
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0963207
LAB Type Rural Health Clinic
Facility Name FAMILY MEDICAL CENTER - COPPEROPOLIS
Street 430 SAWMILL CREEK
City COPPEROPOLIS
State CA
ZIP 95228
Phone 209 754-2520
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/27/2024
Certificate Expiration Date 1/26/2026
Facility Type Rural Health Clinic
Lab Director DEAN M. KELAITA MD

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