38D0628068 CLIA NUMBER - CRATER LAKE MEDICAL SOUTH

Laboratory Demographics

  • CLIA Code: 38D0628068
  • Facility Name: CRATER LAKE MEDICAL SOUTH
  • Facility Address: 21990 HWY 62
    SHADY COVE, OR
    ZIP 97539
  • Facility Phone: 541 878-2022
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: LAURA L. SUTHERLAND
  • NPI Number: 1447752035
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 38D0628068
LAB Type Practitioner Other
Facility Name CRATER LAKE MEDICAL SOUTH
Street 21990 HWY 62
City SHADY COVE
State OR
ZIP 97539
Phone 541 878-2022
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/22/2024
Certificate Expiration Date 12/21/2026
Facility Type Practitioner Other
Lab Director LAURA L. SUTHERLAND

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