27D2244044 CLIA NUMBER - ORIGIN HEALTH LLC

Laboratory Demographics

  • CLIA Code: 27D2244044
  • Facility Name: ORIGIN HEALTH LLC
  • Facility Address: 2831 FORT MISSOULA RD, SUITE 232
    MISSOULA, MT
    ZIP 59804
  • Facility Phone: 406 523-5650
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. MERLIN B. FAUSETT
  • NPI Number: 1841835113
  • Taxonomy: 207VM0101X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 27D2244044
LAB Type Physician Office
Facility Name ORIGIN HEALTH LLC
Street 2831 FORT MISSOULA RD, SUITE 232
City MISSOULA
State MT
ZIP 59804
Phone 406 523-5650
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 11/29/2023
Certificate Expiration Date 11/28/2025
Facility Type Physician Office
Lab Director DR. MERLIN B. FAUSETT

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