50D2033564 CLIA NUMBER - EVERGREEN PEDIATRIC CLINIC

Laboratory Demographics

  • CLIA Code: 50D2033564
  • Facility Name: EVERGREEN PEDIATRIC CLINIC
  • Facility Address: 2101 NE 137TH AVE STE 370
    VANCOUVER, WA
    ZIP 98686
  • Facility Phone: 360 892-1635
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: SUSAN CUNEO
  • NPI Number: 1063184141
  • Taxonomy: 335E00000X - Prosthetic/Orthotic Supplier

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CLIA Record

Field Name Field Value
CLIA Number 50D2033564
LAB Type Physician Office
Facility Name EVERGREEN PEDIATRIC CLINIC
Street 2101 NE 137TH AVE STE 370
City VANCOUVER
State WA
ZIP 98686
Phone 360 892-1635
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/6/2011
Certificate Expiration Date 4/4/2028
Facility Type Physician Office
Lab Director SUSAN CUNEO

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This page was last updated on: 6/4/2025