50D0691211 CLIA NUMBER - MONTESANO INTERNAL MEDICINE CLINIC

Laboratory Demographics

  • CLIA Code: 50D0691211
  • Facility Name: MONTESANO INTERNAL MEDICINE CLINIC
  • Facility Address: 112 EAST BROADWAY
    MONTESANO, WA
    ZIP 98563
  • Facility Phone: 360 249-4111
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: YOUNG KI Y. SHIN
  • NPI Number: 1801981105
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 50D0691211
LAB Type Physician Office
Facility Name MONTESANO INTERNAL MEDICINE CLINIC
Street 112 EAST BROADWAY
City MONTESANO
State WA
ZIP 98563
Phone 360 249-4111
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 Physician Office
Lab Director YOUNG KI Y. SHIN

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