50D0629281 CLIA NUMBER - OVERLAKE CLINICS OBGYN BELLEGROVE

Laboratory Demographics

  • CLIA Code: 50D0629281
  • Facility Name: OVERLAKE CLINICS OBGYN BELLEGROVE
  • Facility Address: 1200 112TH AVE NE BLDG C STE 115
    BELLEVUE, WA
    ZIP 98004
  • Facility Phone: 425 455-0244
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MITCHELL A. NUDELMAN
  • NPI Number: 1104931039
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 50D0629281
LAB Type Physician Office
Facility Name OVERLAKE CLINICS OBGYN BELLEGROVE
Street 1200 112TH AVE NE BLDG C STE 115
City BELLEVUE
State WA
ZIP 98004
Phone 425 455-0244
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/1/1992
Certificate Expiration Date 4/4/2028
Facility Type Physician Office
Lab Director MITCHELL A. NUDELMAN

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