50D1072079 CLIA NUMBER - PROLIANCE EVERETT BONE AND JOINT SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 50D1072079
  • Facility Name: PROLIANCE EVERETT BONE AND JOINT SURGERY CENTER
  • Facility Address: 1100 PACIFIC AVE STE 100
    EVERETT, WA
    ZIP 98201
  • Facility Phone: (425) 317-8535
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: TODD HAVENER
  • NPI Number: 1760421846
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 50D1072079
LAB Type Ambulatory Surgery Center
Facility Name PROLIANCE EVERETT BONE AND JOINT SURGERY CENTER
Street 1100 PACIFIC AVE STE 100
City EVERETT
State WA
ZIP 98201
Phone 4253178535
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/8/2007
Certificate Expiration Date 4/4/2028
Facility Type Ambulatory Surgery Center
Lab Director TODD HAVENER

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This page was last updated on: 5/18/2026