05D2065510 CLIA NUMBER - MODOC MEDICAL CENTER - FAMILY PRACTICE CLINIC

Laboratory Demographics

  • CLIA Code: 05D2065510
  • Facility Name: MODOC MEDICAL CENTER - FAMILY PRACTICE CLINIC
  • Facility Address: 1111 N NAGLE STREET
    ALTURAS, CA
    ZIP 96101
  • Facility Phone: 530 233-7052
  • Facility Type: Rural Health Clinic
  • Facility Type: Microscopy
  • Lab Director: EDWARD P. RICHERT
  • NPI Number: 1487669032
  • Taxonomy: 282NC0060X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 05D2065510
LAB Type Rural Health Clinic
Facility Name MODOC MEDICAL CENTER - FAMILY PRACTICE CLINIC
Street 1111 N NAGLE STREET
City ALTURAS
State CA
ZIP 96101
Phone 530 233-7052
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 9/10/2025
Certificate Expiration Date 9/9/2027
Facility Type Rural Health Clinic
Lab Director EDWARD P. RICHERT

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