38D2015042 CLIA NUMBER - NORTHWEST VASCULAR CONSULTANTS

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Laboratory Demographics

CLIA Number: 38D2015042

Facility Name: NORTHWEST VASCULAR CONSULTANTS

Facility Address:
9701 SW BARNES RD #140
PORTLAND, OR
ZIP 97225
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Facility Phone Number: 503 292-9565

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1861438327

Taxonomy: 2086S0129X - Surgery
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

CLIA Record

Field Name	Field Value
CLIA Number	38D2015042
LAB Type	Physician Office
Facility Name	NORTHWEST VASCULAR CONSULTANTS
Street	9701 SW BARNES RD #140
City	PORTLAND
State	OR
ZIP	97225
Phone	503 292-9565
CertificateType	4
CertificateEffectiveDate	10/21/2022
CertificateExpirationDate	10/20/2024
FacilityType	Waiver

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