05D2039442 CLIA NUMBER - MERCY LAKE SHASTINA COMMUNITY CLINIC

Laboratory Demographics

  • CLIA Code: 05D2039442
  • Facility Name: MERCY LAKE SHASTINA COMMUNITY CLINIC
  • Facility Address: 16337 EVERHART DRIVE
    WEED, CA
    ZIP 96094
  • Facility Phone: 530 938-2297
  • Facility Type: Rural Health Clinic
  • Facility Type: Microscopy
  • Lab Director: DANIEL PURTZER
  • NPI Number: 1255609699
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2039442
LAB Type Rural Health Clinic
Facility Name MERCY LAKE SHASTINA COMMUNITY CLINIC
Street 16337 EVERHART DRIVE
City WEED
State CA
ZIP 96094
Phone 530 938-2297
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 4/10/2024
Certificate Expiration Date 4/9/2026
Facility Type Rural Health Clinic
Lab Director DANIEL PURTZER

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