38D0623645 CLIA NUMBER - OLD TOWN CLINIC - CENTRAL CITY CONCERN

Laboratory Demographics

  • CLIA Code: 38D0623645
  • Facility Name: OLD TOWN CLINIC - CENTRAL CITY CONCERN
  • Facility Address: 727 W BURNSIDE ST
    PORTLAND, OR
    ZIP 97209
  • Facility Phone: 503 294-1681
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: ANDREW B. MENDENHALL
  • NPI Number: 1114230331
  • Taxonomy: 3336C0002X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D0623645
LAB Type Federally Qualified Health Center
Facility Name OLD TOWN CLINIC - CENTRAL CITY CONCERN
Street 727 W BURNSIDE ST
City PORTLAND
State OR
ZIP 97209
Phone 503 294-1681
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 1/1/2024
Certificate Expiration Date 12/31/2025
Facility Type Federally Qualified Health Center
Lab Director ANDREW B. MENDENHALL

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