38D1069788 CLIA NUMBER - CEDAR CREEK INTERNAL MEDICINE PC

Laboratory Demographics

  • CLIA Code: 38D1069788
  • Facility Name: CEDAR CREEK INTERNAL MEDICINE PC
  • Facility Address: 10200 SW EASTRIDGE ST SUITE 205
    PORTLAND, OR
    ZIP 97225
  • Facility Phone: 503 280-4555
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRADLEY J FANCHER MD
  • NPI Number: 1265517437
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 38D1069788
LAB Type Physician Office
Facility Name CEDAR CREEK INTERNAL MEDICINE PC
Street 10200 SW EASTRIDGE ST SUITE 205
City PORTLAND
State OR
ZIP 97225
Phone 503 280-4555
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/13/2025
Certificate Expiration Date 6/12/2027
Facility Type Physician Office
Lab Director BRADLEY J FANCHER MD

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