50D0681387 CLIA NUMBER - BLAINE FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 50D0681387
  • Facility Name: BLAINE FAMILY MEDICINE
  • Facility Address: 861 GRANT AVE
    BLAINE, WA
    ZIP 98230
  • Facility Phone: 360 371-5855
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: JOSEPH BANHAM
  • NPI Number: 1720014921
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 50D0681387
LAB Type Community Clinic
Facility Name BLAINE FAMILY MEDICINE
Street 861 GRANT AVE
City BLAINE
State WA
ZIP 98230
Phone 360 371-5855
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 Community Clinic
Lab Director JOSEPH BANHAM

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