38D0064626 CLIA NUMBER - GATEWAY MEDICAL OFFICE LAB

Laboratory Demographics

  • CLIA Code: 38D0064626
  • Facility Name: GATEWAY MEDICAL OFFICE LAB
  • Facility Address: 1700 NE 102ND AVE
    PORTLAND, OR
    ZIP 97220
  • Facility Phone: 971 229-6810
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANNE AVERY
  • NPI Number: 1205477312
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D0064626
LAB Type Physician Office
Facility Name GATEWAY MEDICAL OFFICE LAB
Street 1700 NE 102ND AVE
City PORTLAND
State OR
ZIP 97220
Phone 971 229-6810
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/5/2023
Certificate Expiration Date 11/4/2025
Facility Type Physician Office
Lab Director ANNE AVERY

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