50D0637268 CLIA NUMBER - WILLAPA MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 50D0637268
  • Facility Name: WILLAPA MEDICAL CLINIC
  • Facility Address: 826 ALDER ST
    SOUTH BEND, WA
    ZIP 98586
  • Facility Phone: 360 875-5579
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SANDRA MONTGOMERY
  • NPI Number: 1760582522
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 50D0637268
LAB Type Physician Office
Facility Name WILLAPA MEDICAL CLINIC
Street 826 ALDER ST
City SOUTH BEND
State WA
ZIP 98586
Phone 360 875-5579
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/24/2005
Certificate Expiration Date 4/4/2028
Facility Type Physician Office
Lab Director SANDRA MONTGOMERY

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