50D0638897 CLIA NUMBER - PALOUSE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 50D0638897
  • Facility Name: PALOUSE PEDIATRICS
  • Facility Address: 1205 SE PROFESSIONAL MALL STE 104
    PULLMAN, WA
    ZIP 99163
  • Facility Phone: 509 332-2605
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL J. FROSTAD
  • NPI Number: 1649253758
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 50D0638897
LAB Type Physician Office
Facility Name PALOUSE PEDIATRICS
Street 1205 SE PROFESSIONAL MALL STE 104
City PULLMAN
State WA
ZIP 99163
Phone 509 332-2605
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/19/2006
Certificate Expiration Date 4/4/2028
Facility Type Physician Office
Lab Director MICHAEL J. FROSTAD

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