50D2129687 CLIA NUMBER - VINTAGE DIRECT PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 50D2129687
  • Facility Name: VINTAGE DIRECT PRIMARY CARE
  • Facility Address: 25985 BARBER CUT OFF RD STE B1
    KINGSTON, WA
    ZIP 98346
  • Facility Phone: 360 860-3020
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PETER LEHMANN
  • NPI Number: 1912423468
  • Taxonomy: 207Q00000X - Family Medicine

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/24/2017
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