38D2046970 CLIA NUMBER - GRACE DERMATOLOGY & MICROGRAPHIC SURGERY LLC

Laboratory Demographics

  • CLIA Code: 38D2046970
  • Facility Name: GRACE DERMATOLOGY & MICROGRAPHIC SURGERY LLC
  • Facility Address: 2500 S MAIN RD
    LEBANON, OR
    ZIP 97355
  • Facility Phone: 541 258-7546
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: KYLE L HORNER MD
  • NPI Number: 1184973828
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 38D2046970
LAB Type Physician Office
Facility Name GRACE DERMATOLOGY & MICROGRAPHIC SURGERY LLC
Street 2500 S MAIN RD
City LEBANON
State OR
ZIP 97355
Phone 541 258-7546
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 12/20/2024
Certificate Expiration Date 12/19/2026
Facility Type Physician Office
Lab Director KYLE L HORNER MD

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