38D2194671 CLIA NUMBER - SOUTH COAST HEALTHCARE, LLC

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Laboratory Demographics

CLIA Number: 38D2194671

Facility Name: SOUTH COAST HEALTHCARE, LLC

Facility Address:
29641 ELLENSBURG AVENUE
GOLD BEACH, OR
ZIP 97444
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Facility Phone Number: 541 425-5657

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1134740152

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D2194671
LAB Type	Physician Office
Facility Name	SOUTH COAST HEALTHCARE, LLC
Street	29641 ELLENSBURG AVENUE
City	GOLD BEACH
State	OR
ZIP	97444
Phone	541 425-5657
CertificateType	3
CertificateEffectiveDate	10/2/2022
CertificateExpirationDate	10/1/2024
FacilityType	PPMP

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