50D2067566 CLIA NUMBER - PROVIDENCE OCCUPATIONAL MEDICINE - MILL PLAIN

Laboratory Demographics

  • CLIA Code: 50D2067566
  • Facility Name: PROVIDENCE OCCUPATIONAL MEDICINE - MILL PLAIN
  • Facility Address: 315 SE STONE MILL DR STE 200
    VANCOUVER, WA
    ZIP 98684
  • Facility Phone: 360 836-3320
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MARY T. PIERCE
  • NPI Number: 1982030656
  • Taxonomy: 261QX0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 50D2067566
LAB Type Practitioner Other
Facility Name PROVIDENCE OCCUPATIONAL MEDICINE - MILL PLAIN
Street 315 SE STONE MILL DR STE 200
City VANCOUVER
State WA
ZIP 98684
Phone 360 836-3320
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/17/2013
Certificate Expiration Date 4/4/2028
Facility Type Practitioner Other
Lab Director MARY T. PIERCE

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