38D2179520 CLIA NUMBER - HEARTHSIDE MEDICINE FAMILY CARE

Laboratory Demographics

  • CLIA Code: 38D2179520
  • Facility Name: HEARTHSIDE MEDICINE FAMILY CARE
  • Facility Address: 339 SW CENTURY DR, STE 201
    BEND, OR
    ZIP 97702
  • Facility Phone: 541 316-5693
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JEREMY BRODHEAD
  • NPI Number: 1477051795
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 38D2179520
LAB Type Practitioner Other
Facility Name HEARTHSIDE MEDICINE FAMILY CARE
Street 339 SW CENTURY DR, STE 201
City BEND
State OR
ZIP 97702
Phone 541 316-5693
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/25/2024
Certificate Expiration Date 2/24/2026
Facility Type Practitioner Other
Lab Director JEREMY BRODHEAD

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