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38D2190859 CLIA NUMBER - PACIFIC UNIVERSITY SPORTS MEDICINE CLINIC

Laboratory Demographics

CLIA Number: 38D2190859

Facility Name: PACIFIC UNIVERSITY SPORTS MEDICINE CLINIC

Facility Address:
2331 MAIN STREET
FOREST GROVE, OR
ZIP 97116
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Facility Phone Number: 503 352-2896

Facility Type: Practitioner Other

Certificate Type: Waiver
NPI Number: 1629421805

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name Field Value
CLIA Number 38D2190859
LAB Type Practitioner Other
Facility Name PACIFIC UNIVERSITY SPORTS MEDICINE CLINIC
Street 2331 MAIN STREET
City FOREST GROVE
State OR
ZIP 97116
Phone 503 352-2896
CertificateType 4
CertificateEffectiveDate 8/19/2022
CertificateExpirationDate 8/18/2024
FacilityType Waiver

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