38D1060111 CLIA NUMBER - CORVALLIS CLINIC SURGERY CENTER,THE

Laboratory Demographics

CLIA Number: 38D1060111

Facility Name: CORVALLIS CLINIC SURGERY CENTER,THE

Facility Address:
601 NW ELKS DRIVE
CORVALLIS, OR
ZIP 97330
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Facility Phone Number: 541 754-1254

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1881850386

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D1060111
LAB Type	Ambulatory Surgery Center
Facility Name	CORVALLIS CLINIC SURGERY CENTER,THE
Street	601 NW ELKS DRIVE
City	CORVALLIS
State	OR
ZIP	97330
Phone	541 754-1254
CertificateType	4
CertificateEffectiveDate	10/16/2022
CertificateExpirationDate	10/15/2024
FacilityType	Waiver

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