38D2203955 CLIA NUMBER - PROVIDENCE MEDICAL GROUP SHERWOOD IMMEDIATE CARE

Laboratory Demographics

  • CLIA Code: 38D2203955
  • Facility Name: PROVIDENCE MEDICAL GROUP SHERWOOD IMMEDIATE CARE
  • Facility Address: 16770 SW EDY ROAD, SUITE 102
    SHERWOOD, OR
    ZIP 97140
  • Facility Phone: 503 216-9600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LINDSAY SPARKS
  • NPI Number: 1013143478
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 38D2203955
LAB Type Physician Office
Facility Name PROVIDENCE MEDICAL GROUP SHERWOOD IMMEDIATE CARE
Street 16770 SW EDY ROAD, SUITE 102
City SHERWOOD
State OR
ZIP 97140
Phone 503 216-9600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/7/2024
Certificate Expiration Date 12/6/2026
Facility Type Physician Office
Lab Director LINDSAY SPARKS

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