38D2057782 CLIA NUMBER - OREGON INTERNAL MEDICINE LLC

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Laboratory Demographics

CLIA Number: 38D2057782

Facility Name: OREGON INTERNAL MEDICINE LLC

Facility Address:
2380 W MAIN ST SUITE A
MEDFORD, OR
ZIP 97501
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Facility Phone Number: 541 858-7183

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1265745541

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	38D2057782
LAB Type	Physician Office
Facility Name	OREGON INTERNAL MEDICINE LLC
Street	2380 W MAIN ST SUITE A
City	MEDFORD
State	OR
ZIP	97501
Phone	541 858-7183
CertificateType	4
CertificateEffectiveDate	4/23/2023
CertificateExpirationDate	4/22/2025
FacilityType	Waiver

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