05D2076656 CLIA NUMBER - SUTTER LAKESIDE COMMUNITY CLINIC

Laboratory Demographics

  • CLIA Code: 05D2076656
  • Facility Name: SUTTER LAKESIDE COMMUNITY CLINIC
  • Facility Address: 5196 HILL RD E STE 300
    LAKEPORT, CA
    ZIP 95453
  • Facility Phone: 707 263-6885
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ELYSE M. DONALD
  • NPI Number: 1063407229
  • Taxonomy: 282NR1301X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 05D2076656
LAB Type Physician Office
Facility Name SUTTER LAKESIDE COMMUNITY CLINIC
Street 5196 HILL RD E STE 300
City LAKEPORT
State CA
ZIP 95453
Phone 707 263-6885
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 10/6/2025
Certificate Expiration Date 10/5/2027
Facility Type Physician Office
Lab Director ELYSE M. DONALD

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