38D2205975 CLIA NUMBER - SOUTHERN OREGON WELLNESS CLINIC, LLC

Laboratory Demographics

  • CLIA Code: 38D2205975
  • Facility Name: SOUTHERN OREGON WELLNESS CLINIC, LLC
  • Facility Address: 547 E PINE STREET, STE 101
    CENTRAL POINT, OR
    ZIP 97502
  • Facility Phone: 541 200-3104
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TIA C. ADACHI
  • NPI Number: 1790295350
  • Taxonomy: 103K00000X - Behavior Analyst

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CLIA Record

Field Name Field Value
CLIA Number 38D2205975
LAB Type Physician Office
Facility Name SOUTHERN OREGON WELLNESS CLINIC, LLC
Street 547 E PINE STREET, STE 101
City CENTRAL POINT
State OR
ZIP 97502
Phone 541 200-3104
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/16/2024
Certificate Expiration Date 12/15/2026
Facility Type Physician Office
Lab Director TIA C. ADACHI

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