50D0634763 CLIA NUMBER - PEACEHEALTH MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 50D0634763
  • Facility Name: PEACEHEALTH MEDICAL GROUP
  • Facility Address: 1990 HOSPITAL DR STE 200
    SEDRO WOOLLEY, WA
    ZIP 98284
  • Facility Phone: (360) 856-8800
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: TABITHA A. NENNINGER
  • NPI Number: 1144664954
  • Taxonomy: 282NC0060X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 50D0634763
LAB Type Physician Office
Facility Name PEACEHEALTH MEDICAL GROUP
Street 1990 HOSPITAL DR STE 200
City SEDRO WOOLLEY
State WA
ZIP 98284
Phone 3608568800
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 7/31/2002
Certificate Expiration Date 4/4/2028
Facility Type Physician Office
Lab Director TABITHA A. NENNINGER

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This page was last updated on: 5/18/2026