05D2322736 CLIA NUMBER - SAC HEALTH SYSTEM BLYTHE 110

Laboratory Demographics

  • CLIA Code: 05D2322736
  • Facility Name: SAC HEALTH SYSTEM BLYTHE 110
  • Facility Address: 126 NORTH SPRING SUITE 110
    BLYTHE, CA
    ZIP 92225
  • Facility Phone: 909 382-7100
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: JAMES CROUNSE
  • NPI Number: 1528836103
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2322736
LAB Type Federally Qualified Health Center
Facility Name SAC HEALTH SYSTEM BLYTHE 110
Street 126 NORTH SPRING SUITE 110
City BLYTHE
State CA
ZIP 92225
Phone 909 382-7100
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 4/25/2025
Certificate Expiration Date 4/24/2027
Facility Type Federally Qualified Health Center
Lab Director JAMES CROUNSE

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