38D1045829 CLIA NUMBER - TILLAMOOK COUNTY CORRECTIONAL FACILITY

Laboratory Demographics

  • CLIA Code: 38D1045829
  • Facility Name: TILLAMOOK COUNTY CORRECTIONAL FACILITY
  • Facility Address: 5995 LONG PRAIRIE RD
    TILLAMOOK, OR
    ZIP 97141
  • Facility Phone: 503 815-2445
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DUSTIN V. SHACKLETON
  • NPI Number: 1013471440
  • Taxonomy: 347E00000X - Transportation Broker

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CLIA Record

Field Name Field Value
CLIA Number 38D1045829
LAB Type Practitioner Other
Facility Name TILLAMOOK COUNTY CORRECTIONAL FACILITY
Street 5995 LONG PRAIRIE RD
City TILLAMOOK
State OR
ZIP 97141
Phone 503 815-2445
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/23/2025
Certificate Expiration Date 9/22/2027
Facility Type Practitioner Other
Lab Director DUSTIN V. SHACKLETON

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