05D2155228 CLIA NUMBER - PROVIDENCE MEDICAL FOUNDATION

Laboratory Demographics

  • CLIA Code: 05D2155228
  • Facility Name: PROVIDENCE MEDICAL FOUNDATION
  • Facility Address: 3200 WALFORD AVE
    EUREKA, CA
    ZIP 95503
  • Facility Phone: 707 445-3443
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DEEPAK STOKES
  • NPI Number: 1386937225
  • Taxonomy: 207X00000X - Orthopaedic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 05D2155228
LAB Type Physician Office
Facility Name PROVIDENCE MEDICAL FOUNDATION
Street 3200 WALFORD AVE
City EUREKA
State CA
ZIP 95503
Phone 707 445-3443
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 9/25/2024
Certificate Expiration Date 9/24/2026
Facility Type Physician Office
Lab Director DEEPAK STOKES

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