38D2294313 CLIA NUMBER - PORTLAND STREET MEDICINE

Laboratory Demographics

  • CLIA Code: 38D2294313
  • Facility Name: PORTLAND STREET MEDICINE
  • Facility Address: 2717 NE BROADWAY
    PORTLAND, OR
    ZIP 97232
  • Facility Phone: 503 501-1231
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: ALEX SKOG
  • NPI Number: 1508857657
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 38D2294313
LAB Type Mobile Laboratory
Facility Name PORTLAND STREET MEDICINE
Street 2717 NE BROADWAY
City PORTLAND
State OR
ZIP 97232
Phone 503 501-1231
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/21/2023
Certificate Expiration Date 11/20/2025
Facility Type Mobile Laboratory
Lab Director ALEX SKOG

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This page was last updated on: 3/20/2025