38D2231045 CLIA NUMBER - ROGUE MEDICAL LLC

Laboratory Demographics

  • CLIA Code: 38D2231045
  • Facility Name: ROGUE MEDICAL LLC
  • Facility Address: 205 N PHOENIX RD, STE T
    PHOENIX, OR
    ZIP 97535
  • Facility Phone: 541 237-8163
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: BEN D. JOHNSON PA
  • NPI Number: 1265298400
  • Taxonomy: 363AM0700X - Physician Assistant

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CLIA Record

Field Name Field Value
CLIA Number 38D2231045
LAB Type Practitioner Other
Facility Name ROGUE MEDICAL LLC
Street 205 N PHOENIX RD, STE T
City PHOENIX
State OR
ZIP 97535
Phone 541 237-8163
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/29/2023
Certificate Expiration Date 7/28/2025
Facility Type Practitioner Other
Lab Director BEN D. JOHNSON PA

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This page was last updated on: 6/4/2025