05D2002593 CLIA NUMBER - MODESOT ADVANCED IMAGING CENTER-MCHENRY

Laboratory Demographics

  • CLIA Code: 05D2002593
  • Facility Name: MODESOT ADVANCED IMAGING CENTER-MCHENRY
  • Facility Address: 1239 MCHENRY AVE, SUITE A
    MODESTO, CA
    ZIP 95350
  • Facility Phone: 209 491-5200
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: MICHAEL C. DUMARS
  • NPI Number: 1477686996
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 05D2002593
LAB Type Ancillary Testing Site in Health Care Center
Facility Name MODESOT ADVANCED IMAGING CENTER-MCHENRY
Street 1239 MCHENRY AVE, SUITE A
City MODESTO
State CA
ZIP 95350
Phone 209 491-5200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/21/2024
Certificate Expiration Date 1/20/2026
Facility Type Ancillary Testing Site in Health Care Center
Lab Director MICHAEL C. DUMARS

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