38D2278125 CLIA NUMBER - OUTSIDE IN-IDUHS

Laboratory Demographics

CLIA Number: 38D2278125

Facility Name: OUTSIDE IN-IDUHS

Facility Address:
1219 SW MAIN ST
PORTLAND, OR
ZIP 97205
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Facility Phone Number: 503 535-3847

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1831697259

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D2278125
LAB Type	Federally Qualified Health Center
Facility Name	OUTSIDE IN-IDUHS
Street	1219 SW MAIN ST
City	PORTLAND
State	OR
ZIP	97205
Phone	503 535-3847
CertificateType	4
CertificateEffectiveDate	3/13/2023
CertificateExpirationDate	3/12/2025
FacilityType	Waiver

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