38D0621896 CLIA NUMBER - ROBERTS STREET CLINIC, PC

Laboratory Demographics

  • CLIA Code: 38D0621896
  • Facility Name: ROBERTS STREET CLINIC, PC
  • Facility Address: 400 NE ROBERTS AVE
    GRESHAM, OR
    ZIP 97030
  • Facility Phone: 503 669-3066
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MATTHEW C. UPSHAW
  • NPI Number: 1003024423
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 38D0621896
LAB Type Physician Office
Facility Name ROBERTS STREET CLINIC, PC
Street 400 NE ROBERTS AVE
City GRESHAM
State OR
ZIP 97030
Phone 503 669-3066
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 6/5/2024
Certificate Expiration Date 6/4/2026
Facility Type Physician Office
Lab Director MATTHEW C. UPSHAW

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