38D0958698 CLIA NUMBER - LAKE ROAD DIALYSIS

Laboratory Demographics

  • CLIA Code: 38D0958698
  • Facility Name: LAKE ROAD DIALYSIS
  • Facility Address: 6902 SE LAKE RD STE 100
    MILWAUKIE, OR
    ZIP 97267
  • Facility Phone: 503 794-1288
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: JASON DEVILLE MD
  • NPI Number: 1700832318
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 38D0958698
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LAKE ROAD DIALYSIS
Street 6902 SE LAKE RD STE 100
City MILWAUKIE
State OR
ZIP 97267
Phone 503 794-1288
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 End Stage Renal Disease Dialysis Facility
Lab Director JASON DEVILLE MD

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