38D0860602 CLIA NUMBER - PINE EAGLE CLINIC

Laboratory Demographics

CLIA Number: 38D0860602

Facility Name: PINE EAGLE CLINIC

Facility Address:
218 N PINE ST
HALFWAY, OR
ZIP 97834
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Facility Phone Number: 541 742-5023

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1922102128

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D0860602
LAB Type	Rural Health Clinic
Facility Name	PINE EAGLE CLINIC
Street	218 N PINE ST
City	HALFWAY
State	OR
ZIP	97834
Phone	541 742-5023
CertificateType	4
CertificateEffectiveDate	9/21/2023
CertificateExpirationDate	9/20/2025
FacilityType	Waiver

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