05D2110223 CLIA NUMBER - INDIAN VALLEY MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 05D2110223
  • Facility Name: INDIAN VALLEY MEDICAL CLINIC
  • Facility Address: 174 HOT SPRINGS RD
    GREENVILLE, CA
    ZIP 95947
  • Facility Phone: 530 284-6116
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: MICHAEL POWELL
  • NPI Number: 1881068708
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2110223
LAB Type Rural Health Clinic
Facility Name INDIAN VALLEY MEDICAL CLINIC
Street 174 HOT SPRINGS RD
City GREENVILLE
State CA
ZIP 95947
Phone 530 284-6116
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/16/2024
Certificate Expiration Date 5/15/2026
Facility Type Rural Health Clinic
Lab Director MICHAEL POWELL

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