38D0987219 CLIA NUMBER - BEAVERTON WEIGHT LOSS & FAM PRACTICE

Laboratory Demographics

CLIA Number: 38D0987219

Facility Name: BEAVERTON WEIGHT LOSS & FAM PRACTICE

Facility Address:
13292 SW 161ST PLACE
TIGARD, OR
ZIP 97223
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Facility Phone Number: 503 330-7025

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1902013725

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D0987219
LAB Type	Federally Qualified Health Center
Facility Name	BEAVERTON WEIGHT LOSS & FAM PRACTICE
Street	13292 SW 161ST PLACE
City	TIGARD
State	OR
ZIP	97223
Phone	503 330-7025
CertificateType	3
CertificateEffectiveDate	5/31/2023
CertificateExpirationDate	5/30/2025
FacilityType	PPMP

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