50D2231342 CLIA NUMBER - PROVIDENCE OCCUPATIONAL MEDICNE

Laboratory Demographics

  • CLIA Code: 50D2231342
  • Facility Name: PROVIDENCE OCCUPATIONAL MEDICNE
  • Facility Address: 11919 W SUNSET HWY STE D
    AIRWAY HEIGHTS, WA
    ZIP 99001
  • Facility Phone: 509 474-2650
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LEDEL JAN RAMOS

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CLIA Record

Field Name Field Value
CLIA Number 50D2231342
LAB Type Physician Office
Facility Name PROVIDENCE OCCUPATIONAL MEDICNE
Street 11919 W SUNSET HWY STE D
City AIRWAY HEIGHTS
State WA
ZIP 99001
Phone 509 474-2650
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/2/2021
Certificate Expiration Date 4/4/2028
Facility Type Physician Office
Lab Director LEDEL JAN RAMOS

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