38D1080786 CLIA NUMBER - PORTLAND CLINIC-ALBERTY SUGICAL CENTER, THE

Laboratory Demographics

CLIA Number: 38D1080786

Facility Name: PORTLAND CLINIC-ALBERTY SUGICAL CENTER, THE

Facility Address:
9100 SW OLESON RD
TIGARD, OR
ZIP 97223
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Facility Phone Number: 503 221-0161

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Waiver

NPI Number: 1508040486

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D1080786
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	PORTLAND CLINIC-ALBERTY SUGICAL CENTER, THE
Street	9100 SW OLESON RD
City	TIGARD
State	OR
ZIP	97223
Phone	503 221-0161
CertificateType	4
CertificateEffectiveDate	3/1/2024
CertificateExpirationDate	2/28/2026
FacilityType	Waiver

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