38D1064033 CLIA NUMBER - SOUTH RIVER COMMUNITY HEALTH CLINIC - ADAPT, INC

Laboratory Demographics

  • CLIA Code: 38D1064033
  • Facility Name: SOUTH RIVER COMMUNITY HEALTH CLINIC - ADAPT, INC
  • Facility Address: FIRST FLOOR MEDICAL CLINIC 621 W MADRONE ST
    ROSEBURG, OR
    ZIP 97470
  • Facility Phone: 541 672-2691
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: THERESA M. LUNDY
  • NPI Number: 1912061755
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 38D1064033
LAB Type Federally Qualified Health Center
Facility Name SOUTH RIVER COMMUNITY HEALTH CLINIC - ADAPT, INC
Street FIRST FLOOR MEDICAL CLINIC 621 W MADRONE ST
City ROSEBURG
State OR
ZIP 97470
Phone 541 672-2691
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/26/2025
Certificate Expiration Date 1/25/2027
Facility Type Federally Qualified Health Center
Lab Director THERESA M. LUNDY

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