38D0664024 CLIA NUMBER - LAKE COUNTY PUBLIC HEALTH LAB

Laboratory Demographics

CLIA Number: 38D0664024

Facility Name: LAKE COUNTY PUBLIC HEALTH LAB

Facility Address:
100 NORTH D SREET SUITE 100
LAKEVIEW, OR
ZIP 97630
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Facility Phone Number: 541 947-6045

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1376646380

Taxonomy: 261QP0905X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D0664024
LAB Type	Other
Facility Name	LAKE COUNTY PUBLIC HEALTH LAB
Street	100 NORTH D SREET SUITE 100
City	LAKEVIEW
State	OR
ZIP	97630
Phone	541 947-6045
CertificateType	4
CertificateEffectiveDate	9/6/2022
CertificateExpirationDate	9/5/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024