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38D2117186 CLIA NUMBER - FANNO CREEK CLINICAL RESEARCH LAB

Laboratory Demographics

CLIA Number: 38D2117186

Facility Name: FANNO CREEK CLINICAL RESEARCH LAB

Facility Address:
2400 SW VERMONT STREET
PORTLAND, OR
ZIP 97219
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Facility Phone Number: 503 452-0915

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1609876705

Taxonomy: 207R00000X - Internal Medicine
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

CLIA Record

Field Name Field Value
CLIA Number 38D2117186
LAB Type Physician Office
Facility Name FANNO CREEK CLINICAL RESEARCH LAB
Street 2400 SW VERMONT STREET
City PORTLAND
State OR
ZIP 97219
Phone 503 452-0915
CertificateType 4
CertificateEffectiveDate 8/10/2022
CertificateExpirationDate 8/9/2024
FacilityType Waiver

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