27D2293696 CLIA NUMBER - AFFECT PROVIDER GROUP, PC

Laboratory Demographics

  • CLIA Code: 27D2293696
  • Facility Name: AFFECT PROVIDER GROUP, PC
  • Facility Address: 3010 SANTA FE COURT, OFFICE 210
    MISSOULA, MT
    ZIP 59808
  • Facility Phone: 845 769-8758
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: DOUG ELWOOD
  • NPI Number: 1710619580
  • Taxonomy: 251S00000X - Community/Behavioral Health

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 27D2293696
LAB Type Comp. Outpatient Rehab Facility
Facility Name AFFECT PROVIDER GROUP, PC
Street 3010 SANTA FE COURT, OFFICE 210
City MISSOULA
State MT
ZIP 59808
Phone 845 769-8758
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/14/2023
Certificate Expiration Date 11/13/2025
Facility Type Comp. Outpatient Rehab Facility
Lab Director DOUG ELWOOD

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