50D2292515 CLIA NUMBER - LIBERTY LAKE DIRECT PRIMARY CARE, PLLC

Laboratory Demographics

  • CLIA Code: 50D2292515
  • Facility Name: LIBERTY LAKE DIRECT PRIMARY CARE, PLLC
  • Facility Address: 2207 N MOLTER RD STE 203
    LIBERTY LAKE, WA
    ZIP 99019
  • Facility Phone: 509 348-2214
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JARED NELSON
  • NPI Number: 1558048280
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 50D2292515
LAB Type Physician Office
Facility Name LIBERTY LAKE DIRECT PRIMARY CARE, PLLC
Street 2207 N MOLTER RD STE 203
City LIBERTY LAKE
State WA
ZIP 99019
Phone 509 348-2214
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2023
Certificate Expiration Date 4/4/2028
Facility Type Physician Office
Lab Director JARED NELSON

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