50D0722309 CLIA NUMBER - PORT GAMBLE S'KLALLAM CLINIC

Laboratory Demographics

  • CLIA Code: 50D0722309
  • Facility Name: PORT GAMBLE S'KLALLAM CLINIC
  • Facility Address: 32020 LITTLE BOSTON ROAD NE
    KINGSTON, WA
    ZIP 98346
  • Facility Phone: (360) 297-9601
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: THOMAS LOCKE, MD
  • NPI Number: 1043435563
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 50D0722309
LAB Type Community Clinic
Facility Name PORT GAMBLE S'KLALLAM CLINIC
Street 32020 LITTLE BOSTON ROAD NE
City KINGSTON
State WA
ZIP 98346
Phone 3602979601
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Community Clinic
Lab Director THOMAS LOCKE, MD

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This page was last updated on: 6/29/2026