50D2129687 CLIA NUMBER - VINTAGE DIRECT PRIMARY CARE

Laboratory Demographics

CLIA Number: 50D2129687

Facility Name: VINTAGE DIRECT PRIMARY CARE

Facility Address:
25985 BARBER CUT OFF RD STE B1
KINGSTON, WA
ZIP 98346
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Facility Phone Number: 360 860-3020

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1912423468

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	50D2129687
LAB Type	Physician Office
Facility Name	VINTAGE DIRECT PRIMARY CARE
Street	25985 BARBER CUT OFF RD STE B1
City	KINGSTON
State	WA
ZIP	98346
Phone	360 860-3020
CertificateType	4
CertificateEffectiveDate	4/24/2017
CertificateExpirationDate	4/4/2028
FacilityType	Waiver

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This page was last updated on: 4/23/2024