38D2135400 CLIA NUMBER - PROVIDENCE MEDICAL GROUP WEST HILLS PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 38D2135400
  • Facility Name: PROVIDENCE MEDICAL GROUP WEST HILLS PRIMARY CARE
  • Facility Address: 9135 SW BARNES RD SUITE 668
    PORTLAND, OR
    ZIP 97225
  • Facility Phone: 503 216-8250
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. LAN BAN
  • NPI Number: 1417313891
  • Taxonomy: 282N00000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 38D2135400
LAB Type Physician Office
Facility Name PROVIDENCE MEDICAL GROUP WEST HILLS PRIMARY CARE
Street 9135 SW BARNES RD SUITE 668
City PORTLAND
State OR
ZIP 97225
Phone 503 216-8250
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/22/2025
Certificate Expiration Date 8/21/2027
Facility Type Physician Office
Lab Director DR. LAN BAN

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