50D0637777 CLIA NUMBER - EVERGREEN PEDIATRIC CLINIC

Laboratory Demographics

  • CLIA Code: 50D0637777
  • Facility Name: EVERGREEN PEDIATRIC CLINIC
  • Facility Address: 505 NE 87TH AVE STE 120
    VANCOUVER, WA
    ZIP 98664
  • Facility Phone: 360 892-1635
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: SUSAN CUNEO

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 50D0637777
LAB Type Physician Office
Facility Name EVERGREEN PEDIATRIC CLINIC
Street 505 NE 87TH AVE STE 120
City VANCOUVER
State WA
ZIP 98664
Phone 360 892-1635
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 9/11/2015
Certificate Expiration Date 4/4/2028
Facility Type Physician Office
Lab Director SUSAN CUNEO

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 6/4/2025