38D0627472 CLIA NUMBER - WILLAMETTE VALLEY DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 38D0627472
  • Facility Name: WILLAMETTE VALLEY DERMATOLOGY
  • Facility Address: 1605 G ST
    SPRINGFIELD, OR
    ZIP 97477
  • Facility Phone: 541 747-6159
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JOSHUA J. CLARK
  • NPI Number: 1821121344
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 38D0627472
LAB Type Physician Office
Facility Name WILLAMETTE VALLEY DERMATOLOGY
Street 1605 G ST
City SPRINGFIELD
State OR
ZIP 97477
Phone 541 747-6159
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 10/29/2023
Certificate Expiration Date 10/28/2025
Facility Type Physician Office
Lab Director JOSHUA J. CLARK

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