50D0722390 CLIA NUMBER - SQUAXIN ISLAND HEALTH CLINIC

Laboratory Demographics

  • CLIA Code: 50D0722390
  • Facility Name: SQUAXIN ISLAND HEALTH CLINIC
  • Facility Address: SE 90 KLAH CHE MIN DRIVE
    SHELTON, WA
    ZIP 98584
  • Facility Phone: 360 432-3941
  • Facility Type: Other - TRIBAL HEALTH CLINIC
  • Facility Type: Waiver
  • Lab Director: ANGELA TOBIAS
  • NPI Number: 1548378318
  • Taxonomy: 183500000X - Pharmacist

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CLIA Record

Field Name Field Value
CLIA Number 50D0722390
LAB Type Other - TRIBAL HEALTH CLINIC
Facility Name SQUAXIN ISLAND HEALTH CLINIC
Street SE 90 KLAH CHE MIN DRIVE
City SHELTON
State WA
ZIP 98584
Phone 360 432-3941
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/21/2024
Certificate Expiration Date 10/20/2026
Facility Type Other - TRIBAL HEALTH CLINIC
Lab Director ANGELA TOBIAS

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