27D2314252 CLIA NUMBER - BASECAMP PEDIATRICS

Laboratory Demographics

  • CLIA Code: 27D2314252
  • Facility Name: BASECAMP PEDIATRICS
  • Facility Address: 2831 FORT MISSOULA RD SUITE 105
    MISSOULA, MT
    ZIP 59804
  • Facility Phone: 406 241-4577
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: TARA L. PATRICK
  • NPI Number: 1194540120
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 27D2314252
LAB Type Practitioner Other
Facility Name BASECAMP PEDIATRICS
Street 2831 FORT MISSOULA RD SUITE 105
City MISSOULA
State MT
ZIP 59804
Phone 406 241-4577
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/15/2024
Certificate Expiration Date 11/14/2026
Facility Type Practitioner Other
Lab Director TARA L. PATRICK

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