50D0959263 CLIA NUMBER - BONNEY LAKE MEDICAL CENTER

Laboratory Demographics

CLIA Number: 50D0959263

Facility Name: BONNEY LAKE MEDICAL CENTER

Facility Address:
21509 HWY 410 EAST STE 1
BONNEY LAKE, WA
ZIP 98391
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Facility Phone Number: 253 891-2160

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1700056587

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	50D0959263
LAB Type	Other
Facility Name	BONNEY LAKE MEDICAL CENTER
Street	21509 HWY 410 EAST STE 1
City	BONNEY LAKE
State	WA
ZIP	98391
Phone	253 891-2160
CertificateType	4
CertificateEffectiveDate	9/3/2004
CertificateExpirationDate	4/4/2028
FacilityType	Waiver

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This page was last updated on: 4/23/2024