27D1088815 CLIA NUMBER - PROVIDENCE MEDICAL GROUP - GRANT CREEK FAMILY

Laboratory Demographics

  • CLIA Code: 27D1088815
  • Facility Name: PROVIDENCE MEDICAL GROUP - GRANT CREEK FAMILY
  • Facility Address: 3075 NORTH RESERVE, SUITE Q
    MISSOULA, MT
    ZIP 59808
  • Facility Phone: 406 327-1850
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. MARIA WATERS
  • NPI Number: 1316605637
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 27D1088815
LAB Type Physician Office
Facility Name PROVIDENCE MEDICAL GROUP - GRANT CREEK FAMILY
Street 3075 NORTH RESERVE, SUITE Q
City MISSOULA
State MT
ZIP 59808
Phone 406 327-1850
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 2/16/2024
Certificate Expiration Date 2/15/2026
Facility Type Physician Office
Lab Director DR. MARIA WATERS

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