38D0624031 CLIA NUMBER - PROVIDENCE PORTLAND MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 38D0624031
  • Facility Name: PROVIDENCE PORTLAND MEDICAL CENTER
  • Facility Address: 4805 NE GLISAN
    PORTLAND, OR
    ZIP 97213
  • Facility Phone: 503 215-3806
  • Facility Type: Hospital
  • Facility Type: Accreditation
  • Lab Director: JIAN SHEN
  • NPI Number: 1336311554
  • Taxonomy: 2084N0400X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 38D0624031
LAB Type Hospital
Facility Name PROVIDENCE PORTLAND MEDICAL CENTER
Street 4805 NE GLISAN
City PORTLAND
State OR
ZIP 97213
Phone 503 215-3806
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 1/1/2024
Certificate Expiration Date 12/31/2025
Facility Type Hospital
Lab Director JIAN SHEN

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