38D2083722 CLIA NUMBER - CAREATCMEDFORD

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Laboratory Demographics

CLIA Number: 38D2083722

Facility Name: CAREATCMEDFORD

Facility Address:
1101 W MAIN ST SUITE 102
MEDFORD, OR
ZIP 97501
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Facility Phone Number: 918 779-7471

Facility Type: Other - HEALTH CENTER

Certificate Type: Waiver

NPI Number: 1851942536

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D2083722
LAB Type	Other - HEALTH CENTER
Facility Name	CAREATCMEDFORD
Street	1101 W MAIN ST SUITE 102
City	MEDFORD
State	OR
ZIP	97501
Phone	918 779-7471
CertificateType	4
CertificateEffectiveDate	4/8/2023
CertificateExpirationDate	4/7/2025
FacilityType	Waiver

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