50D1031109 CLIA NUMBER - CREEKSIDE MEDICAL

Laboratory Demographics

  • CLIA Code: 50D1031109
  • Facility Name: CREEKSIDE MEDICAL
  • Facility Address: 900 NE 139TH ST STE 202
    VANCOUVER, WA
    ZIP 98685
  • Facility Phone: 360 566-9355
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUPRANEE A. NOPACHAI
  • NPI Number: 1760529374
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 50D1031109
LAB Type Physician Office
Facility Name CREEKSIDE MEDICAL
Street 900 NE 139TH ST STE 202
City VANCOUVER
State WA
ZIP 98685
Phone 360 566-9355
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/23/2004
Certificate Expiration Date 4/4/2028
Facility Type Physician Office
Lab Director SUPRANEE A. NOPACHAI

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