38D2057397 CLIA NUMBER - NE SALEM DIALYSIS

Laboratory Demographics

  • CLIA Code: 38D2057397
  • Facility Name: NE SALEM DIALYSIS
  • Facility Address: 4792 PORTLAND ROAD NE
    SALEM, OR
    ZIP 97305
  • Facility Phone: 503 393-2142
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: PAVAN K. GONA
  • NPI Number: 1194066878
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 38D2057397
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name NE SALEM DIALYSIS
Street 4792 PORTLAND ROAD NE
City SALEM
State OR
ZIP 97305
Phone 503 393-2142
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/16/2025
Certificate Expiration Date 4/15/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director PAVAN K. GONA

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