38D2106661 CLIA NUMBER - PROVIDENCE MILWAUKIE HOSPITAL ANTICOAGULATION CLINIC

Laboratory Demographics

CLIA Code: 38D2106661
Facility Name: PROVIDENCE MILWAUKIE HOSPITAL ANTICOAGULATION CLINIC
Facility Address: 3300 SE DWYER DRIVE, STE 304
MILWAUKIE, OR
ZIP 97222
Facility Phone: 503 513-8343
Facility Type: Ancillary Testing Site in Health Care Center
Facility Type: Waiver
Lab Director: WENDY ECKHART
NPI Number: 1437816659
Taxonomy: 251T00000X - Program of All-Inclusive Care for the Elderly (PACE) Provider Organization

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CLIA Record

Field Name	Field Value
CLIA Number	38D2106661
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	PROVIDENCE MILWAUKIE HOSPITAL ANTICOAGULATION CLINIC
Street	3300 SE DWYER DRIVE, STE 304
City	MILWAUKIE
State	OR
ZIP	97222
Phone	503 513-8343
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	12/22/2023
Certificate Expiration Date	12/21/2025
Facility Type	Ancillary Testing Site in Health Care Center
Lab Director	WENDY ECKHART

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