38D2185620 CLIA NUMBER - GRANDE RONDE HOSPITAL DERMATOLOGY

Laboratory Demographics

CLIA Number: 38D2185620

Facility Name: GRANDE RONDE HOSPITAL DERMATOLOGY

Facility Address:
700 SUNSET DRIVE , SUITE F
LA GRANDE, OR
ZIP 97850
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Facility Phone Number: 541 663-3030

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1477932325

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D2185620
LAB Type	Physician Office
Facility Name	GRANDE RONDE HOSPITAL DERMATOLOGY
Street	700 SUNSET DRIVE , SUITE F
City	LA GRANDE
State	OR
ZIP	97850
Phone	541 663-3030
CertificateType	4
CertificateEffectiveDate	6/5/2022
CertificateExpirationDate	6/4/2024
FacilityType	Waiver

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