38D1015662 CLIA NUMBER - DIANE BOLDUC

Laboratory Demographics

  • CLIA Code: 38D1015662
  • Facility Name: DIANE BOLDUC
  • Facility Address: 340 MEDICAL LOOP
    ROSEBURG, OR
    ZIP 97471
  • Facility Phone: 541 464-5907
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SARAH L. AGSTEN MD
  • NPI Number: 1174537047
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 38D1015662
LAB Type Physician Office
Facility Name DIANE BOLDUC
Street 340 MEDICAL LOOP
City ROSEBURG
State OR
ZIP 97471
Phone 541 464-5907
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/11/2025
Certificate Expiration Date 8/10/2027
Facility Type Physician Office
Lab Director SARAH L. AGSTEN MD

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