38D2008777 CLIA NUMBER - MOUNTAIN SAGE MEDICAL

Laboratory Demographics

  • CLIA Code: 38D2008777
  • Facility Name: MOUNTAIN SAGE MEDICAL
  • Facility Address: 42 S BROADWAY
    BURNS, OR
    ZIP 97720
  • Facility Phone: 541 573-7988
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THOMAS M FITZPATRICK MD
  • NPI Number: 1942529565
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 38D2008777
LAB Type Physician Office
Facility Name MOUNTAIN SAGE MEDICAL
Street 42 S BROADWAY
City BURNS
State OR
ZIP 97720
Phone 541 573-7988
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/17/2024
Certificate Expiration Date 6/16/2026
Facility Type Physician Office
Lab Director THOMAS M FITZPATRICK MD

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