05D2110223 CLIA NUMBER - INDIAN VALLEY MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 05D2110223

Facility Name: INDIAN VALLEY MEDICAL CLINIC

Facility Address:
174 HOT SPRINGS RD
GREENVILLE, CA
ZIP 95947
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Facility Phone Number: 530 284-6116

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1881068708

Taxonomy: 261QR1300X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	5/16/2022
CertificateExpirationDate	5/15/2024
FacilityType	Waiver

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