38D2073010 CLIA NUMBER - ROGUE FUNCTIONAL WELLNESS LLC

Laboratory Demographics

  • CLIA Code: 38D2073010
  • Facility Name: ROGUE FUNCTIONAL WELLNESS LLC
  • Facility Address: 761 GOLF VIEW DR STE C
    MEDFORD, OR
    ZIP 97504
  • Facility Phone: 541 210-9520
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JASON D. JEX
  • NPI Number: 1336485846
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 38D2073010
LAB Type Practitioner Other
Facility Name ROGUE FUNCTIONAL WELLNESS LLC
Street 761 GOLF VIEW DR STE C
City MEDFORD
State OR
ZIP 97504
Phone 541 210-9520
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/10/2024
Certificate Expiration Date 2/9/2026
Facility Type Practitioner Other
Lab Director JASON D. JEX

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