50D1091792 CLIA NUMBER - PROLIANCE SKAGIT NORTHWEST ORTHOPEDIC SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 50D1091792
  • Facility Name: PROLIANCE SKAGIT NORTHWEST ORTHOPEDIC SURGERY CENTER
  • Facility Address: 1401 S LAVENTURE RD
    MOUNT VERNON, WA
    ZIP 98274
  • Facility Phone: 360 424-2400
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: CAMILLE CONNELLY
  • NPI Number: 1023051489
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 50D1091792
LAB Type Ambulance
Facility Name PROLIANCE SKAGIT NORTHWEST ORTHOPEDIC SURGERY CENTER
Street 1401 S LAVENTURE RD
City MOUNT VERNON
State WA
ZIP 98274
Phone 360 424-2400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/10/2008
Certificate Expiration Date 4/4/2028
Facility Type Ambulance
Lab Director CAMILLE CONNELLY

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