38D0939584 CLIA NUMBER - PROVIDENCE CANNON BEACH CLINIC

Laboratory Demographics

  • CLIA Code: 38D0939584
  • Facility Name: PROVIDENCE CANNON BEACH CLINIC
  • Facility Address: 171 LARCH ST
    CANNON BEACH, OR
    ZIP 97110
  • Facility Phone: 503 717-7400
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: JULIE PAQUETTE
  • NPI Number: 1841756764
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 38D0939584
LAB Type Rural Health Clinic
Facility Name PROVIDENCE CANNON BEACH CLINIC
Street 171 LARCH ST
City CANNON BEACH
State OR
ZIP 97110
Phone 503 717-7400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/1/2024
Certificate Expiration Date 12/31/2025
Facility Type Rural Health Clinic
Lab Director JULIE PAQUETTE

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