05D2108304 CLIA NUMBER - PRIMARY CARE PRACTICE

Laboratory Demographics

CLIA Number: 05D2108304

Facility Name: PRIMARY CARE PRACTICE

Facility Address:
2721 OLIVE HWY STE
OROVILLE, CA
ZIP 95966
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Facility Phone Number: 530 532-3091

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1063750297

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2108304
LAB Type	Rural Health Clinic
Facility Name	PRIMARY CARE PRACTICE
Street	2721 OLIVE HWY STE
City	OROVILLE
State	CA
ZIP	95966
Phone	530 532-3091
CertificateType	4
CertificateEffectiveDate	2/2/2024
CertificateExpirationDate	2/1/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024