38D2015263 CLIA NUMBER - PROVIDENCE CANBY HEALTH CENTER DIAGNOSTIC IMAGING

Laboratory Demographics

  • CLIA Code: 38D2015263
  • Facility Name: PROVIDENCE CANBY HEALTH CENTER DIAGNOSTIC IMAGING
  • Facility Address: 200 S HAZEL DELL WAY
    CANBY, OR
    ZIP 97013
  • Facility Phone: 503 657-6917
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MATTHEW ORTH MD
  • NPI Number: 1184977233
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 38D2015263
LAB Type Physician Office
Facility Name PROVIDENCE CANBY HEALTH CENTER DIAGNOSTIC IMAGING
Street 200 S HAZEL DELL WAY
City CANBY
State OR
ZIP 97013
Phone 503 657-6917
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/25/2024
Certificate Expiration Date 10/24/2026
Facility Type Physician Office
Lab Director MATTHEW ORTH MD

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