38D0712188 CLIA NUMBER - SANTIAM MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 38D0712188

Facility Name: SANTIAM MEDICAL CLINIC

Facility Address:
280 S FIRST AVE
MILL CITY, OR
ZIP 97360
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Facility Phone Number: 503 897-4100

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1396131389

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D0712188
LAB Type	Physician Office
Facility Name	SANTIAM MEDICAL CLINIC
Street	280 S FIRST AVE
City	MILL CITY
State	OR
ZIP	97360
Phone	503 897-4100
CertificateType	4
CertificateEffectiveDate	11/15/2023
CertificateExpirationDate	11/14/2025
FacilityType	Waiver

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