29D2034384 CLIA NUMBER - FORT MCDERMITT WELLNESS CENTER

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Laboratory Demographics

CLIA Number: 29D2034384

Facility Name: FORT MCDERMITT WELLNESS CENTER

Facility Address:
112 N RESERVATION RD
MCDERMITT, NV
ZIP 89421
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Facility Phone Number: 775 532-8522

Facility Type: Other - TRIBAL HEALTH CLINIC

Certificate Type: Waiver

NPI Number: 1801348024

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	29D2034384
LAB Type	Other - TRIBAL HEALTH CLINIC
Facility Name	FORT MCDERMITT WELLNESS CENTER
Street	112 N RESERVATION RD
City	MCDERMITT
State	NV
ZIP	89421
Phone	775 532-8522
CertificateType	4
CertificateEffectiveDate	12/22/2023
CertificateExpirationDate	12/21/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024