38D0903690 CLIA NUMBER - PEACEHEALTH MEDICAL GROUP - 380

Laboratory Demographics

CLIA Number: 38D0903690

Facility Name: PEACEHEALTH MEDICAL GROUP - 380

Facility Address:
380 9TH ST
FLORENCE, OR
ZIP 97439
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Facility Phone Number: 541 902-1640

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1811908668

Taxonomy: 3336C0002X - Pharmacy
A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist.

CLIA Record

Field Name	Field Value
CLIA Number	38D0903690
LAB Type	Physician Office
Facility Name	PEACEHEALTH MEDICAL GROUP - 380
Street	380 9TH ST
City	FLORENCE
State	OR
ZIP	97439
Phone	541 902-1640
CertificateType	4
CertificateEffectiveDate	1/10/2023
CertificateExpirationDate	1/9/2025
FacilityType	Waiver

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