50D2105850 CLIA NUMBER - VINTAGE DIRECT PRIMARY CARE PLLC

Laboratory Demographics

  • CLIA Code: 50D2105850
  • Facility Name: VINTAGE DIRECT PRIMARY CARE PLLC
  • Facility Address: 19319 7TH AVE NE STE 114
    POULSBO, WA
    ZIP 98370
  • Facility Phone: 360 930-3500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PETER LEHMANN
  • NPI Number: 1023530573
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 50D2105850
LAB Type Physician Office
Facility Name VINTAGE DIRECT PRIMARY CARE PLLC
Street 19319 7TH AVE NE STE 114
City POULSBO
State WA
ZIP 98370
Phone 360 930-3500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/4/2015
Certificate Expiration Date 4/4/2028
Facility Type Physician Office
Lab Director PETER LEHMANN

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