27D2005128 CLIA NUMBER - PROVIDENCE MEDICAL GROUP-BROADWAY INTERNAL MED

Laboratory Demographics

  • CLIA Code: 27D2005128
  • Facility Name: PROVIDENCE MEDICAL GROUP-BROADWAY INTERNAL MED
  • Facility Address: 500 W BROADWAY, 4TH FLOOR
    MISSOULA, MT
    ZIP 59806
  • Facility Phone: 406 327-1900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. AKAASH F. ACHARYA
  • NPI Number: 1871825018
  • Taxonomy: 207RN0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 27D2005128
LAB Type Physician Office
Facility Name PROVIDENCE MEDICAL GROUP-BROADWAY INTERNAL MED
Street 500 W BROADWAY, 4TH FLOOR
City MISSOULA
State MT
ZIP 59806
Phone 406 327-1900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2024
Certificate Expiration Date 3/21/2026
Facility Type Physician Office
Lab Director DR. AKAASH F. ACHARYA

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