38D0932318 CLIA NUMBER - LEGACY MEDICAL GROUP MOLALLA FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 38D0932318
  • Facility Name: LEGACY MEDICAL GROUP MOLALLA FAMILY MEDICINE
  • Facility Address: 861 W MAIN ST
    MOLALLA, OR
    ZIP 97038
  • Facility Phone: 503 874-5653
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ELIZABETH J. BLOUNT
  • NPI Number: 1013191535
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 38D0932318
LAB Type Physician Office
Facility Name LEGACY MEDICAL GROUP MOLALLA FAMILY MEDICINE
Street 861 W MAIN ST
City MOLALLA
State OR
ZIP 97038
Phone 503 874-5653
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/26/2024
Certificate Expiration Date 9/25/2026
Facility Type Physician Office
Lab Director ELIZABETH J. BLOUNT

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