05D2069763 CLIA NUMBER - PINE STREET CLINIC

Laboratory Demographics

  • CLIA Code: 05D2069763
  • Facility Name: PINE STREET CLINIC
  • Facility Address: 408 PINE ST
    MOUNT SHASTA, CA
    ZIP 96067
  • Facility Phone: 530 926-9334
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: MATTHEW J. KILPATRICK
  • NPI Number: 1942632534
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2069763
LAB Type Community Clinic
Facility Name PINE STREET CLINIC
Street 408 PINE ST
City MOUNT SHASTA
State CA
ZIP 96067
Phone 530 926-9334
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/5/2024
Certificate Expiration Date 6/4/2026
Facility Type Community Clinic
Lab Director MATTHEW J. KILPATRICK

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