50D1034133 CLIA NUMBER - WILLAPA HARBOR HOSPITAL

Laboratory Demographics

  • CLIA Code: 50D1034133
  • Facility Name: WILLAPA HARBOR HOSPITAL
  • Facility Address: 810 ALDER ST
    SOUTH BEND, WA
    ZIP 98586
  • Facility Phone: 360 875-5526
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SANDRA F. MONTGOMERY
  • NPI Number: 1295708683
  • Taxonomy: 282NC0060X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 50D1034133
LAB Type Physician Office
Facility Name WILLAPA HARBOR HOSPITAL
Street 810 ALDER ST
City SOUTH BEND
State WA
ZIP 98586
Phone 360 875-5526
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/24/2004
Certificate Expiration Date 4/4/2028
Facility Type Physician Office
Lab Director SANDRA F. MONTGOMERY

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