12D1096251 CLIA NUMBER - EAST HAWAII HEALTH CLINIC AT PAHOA

Laboratory Demographics

  • CLIA Code: 12D1096251
  • Facility Name: EAST HAWAII HEALTH CLINIC AT PAHOA
  • Facility Address: 15-2662 PAHOA VILLAGE RD SUITE 303 PMB 8741
    PAHOA, HI
    ZIP 96778
  • Facility Phone: 808 930-6001
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: ANDRE THERIAULT
  • NPI Number: 1174777916
  • Taxonomy: 261QR1300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 12D1096251
LAB Type Rural Health Clinic
Facility Name EAST HAWAII HEALTH CLINIC AT PAHOA
Street 15-2662 PAHOA VILLAGE RD SUITE 303 PMB 8741
City PAHOA
State HI
ZIP 96778
Phone 808 930-6001
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/14/2025
Certificate Expiration Date 8/13/2027
Facility Type Rural Health Clinic
Lab Director ANDRE THERIAULT

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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