38D1072984 CLIA NUMBER - VALLEY IMMEDIATE CARE LLC GRANTS PASS

Laboratory Demographics

CLIA Number: 38D1072984

Facility Name: VALLEY IMMEDIATE CARE LLC GRANTS PASS

Facility Address:
162 NE BEACON DR #103
GRANTS PASS, OR
ZIP 97526
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Facility Phone Number: 541 479-1090

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1821504192

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	38D1072984
LAB Type	Physician Office
Facility Name	VALLEY IMMEDIATE CARE LLC GRANTS PASS
Street	162 NE BEACON DR #103
City	GRANTS PASS
State	OR
ZIP	97526
Phone	541 479-1090
CertificateType	2
CertificateEffectiveDate	1/28/2024
CertificateExpirationDate	1/27/2026
FacilityType	Compliance

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