38D1062243 CLIA NUMBER - ASANTE PHYSICIAN PARTNERS COUMADIN CLINIC RVM

Laboratory Demographics

  • CLIA Code: 38D1062243
  • Facility Name: ASANTE PHYSICIAN PARTNERS COUMADIN CLINIC RVM
  • Facility Address: 1250 MIRA MAR AVENUE
    MEDFORD, OR
    ZIP 97504
  • Facility Phone: 541 789-6385
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DANIELLE ENNIS
  • NPI Number: 1558498279
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 38D1062243
LAB Type Physician Office
Facility Name ASANTE PHYSICIAN PARTNERS COUMADIN CLINIC RVM
Street 1250 MIRA MAR AVENUE
City MEDFORD
State OR
ZIP 97504
Phone 541 789-6385
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Physician Office
Lab Director DANIELLE ENNIS

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