38D1103748 CLIA NUMBER - SOUTHERN OREGON CHILDREN'S CLINIC

Laboratory Demographics

CLIA Number: 38D1103748

Facility Name: SOUTHERN OREGON CHILDREN'S CLINIC

Facility Address:
2921 DOCTOR'S PARK DR
MEDFORD, OR
ZIP 97504
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Facility Phone Number: 541 423-8123

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1538446315

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D1103748
LAB Type	Practitioner Other
Facility Name	SOUTHERN OREGON CHILDREN'S CLINIC
Street	2921 DOCTOR'S PARK DR
City	MEDFORD
State	OR
ZIP	97504
Phone	541 423-8123
CertificateType	4
CertificateEffectiveDate	8/17/2023
CertificateExpirationDate	8/16/2025
FacilityType	Waiver

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