37D2204090 CLIA NUMBER - VARIETY CARE PORTLAND WEST

Laboratory Demographics

  • CLIA Code: 37D2204090
  • Facility Name: VARIETY CARE PORTLAND WEST
  • Facility Address: 5401 N PORTLAND AVE
    OKLAHOMA CITY, OK
    ZIP 73112
  • Facility Phone: 405 632-6688
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: JASON R. GRAHAM
  • NPI Number: 1669787453
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 37D2204090
LAB Type Federally Qualified Health Center
Facility Name VARIETY CARE PORTLAND WEST
Street 5401 N PORTLAND AVE
City OKLAHOMA CITY
State OK
ZIP 73112
Phone 405 632-6688
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 12/8/2024
Certificate Expiration Date 12/7/2026
Facility Type Federally Qualified Health Center
Lab Director JASON R. GRAHAM

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