38D2217399 CLIA NUMBER - SAMARITAN MEDICAL GROUP FAMILY MEDICINE NINTH STREET

Laboratory Demographics

  • CLIA Code: 38D2217399
  • Facility Name: SAMARITAN MEDICAL GROUP FAMILY MEDICINE NINTH STREET
  • Facility Address: 777 NW 9TH STREET #320
    CORVALLIS, OR
    ZIP 97330
  • Facility Phone: 541 768-1840
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRANDI L. BOLLER
  • NPI Number: 1124402565
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 38D2217399
LAB Type Physician Office
Facility Name SAMARITAN MEDICAL GROUP FAMILY MEDICINE NINTH STREET
Street 777 NW 9TH STREET #320
City CORVALLIS
State OR
ZIP 97330
Phone 541 768-1840
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2025
Certificate Expiration Date 3/18/2027
Facility Type Physician Office
Lab Director BRANDI L. BOLLER

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