05D1084391 CLIA NUMBER - MACT MEDICAL SAN ANDREAS

Laboratory Demographics

CLIA Number: 05D1084391

Facility Name: MACT MEDICAL SAN ANDREAS

Facility Address:
1113 HWY 49
SAN ANDREAS, CA
ZIP 95249
Get Directions

Facility Phone Number: 209 754-6262

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1467444364

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	05D1084391
LAB Type	Community Clinic
Facility Name	MACT MEDICAL SAN ANDREAS
Street	1113 HWY 49
City	SAN ANDREAS
State	CA
ZIP	95249
Phone	209 754-6262
CertificateType	4
CertificateEffectiveDate	5/21/2022
CertificateExpirationDate	5/20/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

This page was last updated on: 4/23/2024