05D1092277 CLIA NUMBER - ADVENTIST HEALTH OUTPATIENT PAVILION

Laboratory Demographics

  • CLIA Code: 05D1092277
  • Facility Name: ADVENTIST HEALTH OUTPATIENT PAVILION
  • Facility Address: 245 HOSPITAL DRIVE
    UKIAH, CA
    ZIP 95482
  • Facility Phone: 707 463-7307
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: NICHOLAS HARDING-JACKSON
  • NPI Number: 1558789123
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1092277
LAB Type Ambulatory Surgery Center
Facility Name ADVENTIST HEALTH OUTPATIENT PAVILION
Street 245 HOSPITAL DRIVE
City UKIAH
State CA
ZIP 95482
Phone 707 463-7307
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/20/2024
Certificate Expiration Date 11/19/2026
Facility Type Ambulatory Surgery Center
Lab Director NICHOLAS HARDING-JACKSON

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