50D2105877 CLIA NUMBER - VALLEY ROOTS FAMILY CARE

Laboratory Demographics

  • CLIA Code: 50D2105877
  • Facility Name: VALLEY ROOTS FAMILY CARE
  • Facility Address: 617 W DIVISION ST
    MOUNT VERNON, WA
    ZIP 98273
  • Facility Phone: 360 428-1884
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID B. BENSON
  • NPI Number: 1144693250
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 50D2105877
LAB Type Physician Office
Facility Name VALLEY ROOTS FAMILY CARE
Street 617 W DIVISION ST
City MOUNT VERNON
State WA
ZIP 98273
Phone 360 428-1884
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 DAVID B. BENSON

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