05D1035787 CLIA NUMBER - ESCALON COMMUNITY HEALTH CTR

Laboratory Demographics

  • CLIA Code: 05D1035787
  • Facility Name: ESCALON COMMUNITY HEALTH CTR
  • Facility Address: 2080 MC HENRY AVE SUITE 200
    ESCALON, CA
    ZIP 95320
  • Facility Phone: 209 838-8581
  • Facility Type: Rural Health Clinic
  • Facility Type: Microscopy
  • Lab Director: BOB PETERSON MD
  • NPI Number: 1134478852
  • Taxonomy: 341600000X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 05D1035787
LAB Type Rural Health Clinic
Facility Name ESCALON COMMUNITY HEALTH CTR
Street 2080 MC HENRY AVE SUITE 200
City ESCALON
State CA
ZIP 95320
Phone 209 838-8581
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 1/11/2025
Certificate Expiration Date 1/10/2027
Facility Type Rural Health Clinic
Lab Director BOB PETERSON MD

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