38D2190944 CLIA NUMBER - NORTHWEST SURGICAL SPECIALIST, PC

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Laboratory Demographics

CLIA Number: 38D2190944

Facility Name: NORTHWEST SURGICAL SPECIALIST, PC

Facility Address:
1040 NW 22ND AVE, STE 610
PORTLAND, OR
ZIP 97210
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Facility Phone Number: 360 254-6161

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1710409347

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	38D2190944
LAB Type	Physician Office
Facility Name	NORTHWEST SURGICAL SPECIALIST, PC
Street	1040 NW 22ND AVE, STE 610
City	PORTLAND
State	OR
ZIP	97210
Phone	360 254-6161
CertificateType	4
CertificateEffectiveDate	8/20/2022
CertificateExpirationDate	8/19/2024
FacilityType	Waiver

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