38D2154062 CLIA NUMBER - BIRCH GROVE HEALTH CENTER-LA CLINICA

Laboratory Demographics

CLIA Number: 38D2154062

Facility Name: BIRCH GROVE HEALTH CENTER-LA CLINICA

Facility Address:
910 S CENTRAL AVE
MEDFORD, OR
ZIP 97501
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Facility Phone Number: 541 618-1380

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1417372731

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D2154062
LAB Type	Community Clinic
Facility Name	BIRCH GROVE HEALTH CENTER-LA CLINICA
Street	910 S CENTRAL AVE
City	MEDFORD
State	OR
ZIP	97501
Phone	541 618-1380
CertificateType	3
CertificateEffectiveDate	9/5/2022
CertificateExpirationDate	9/4/2024
FacilityType	PPMP

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