50D2299641 CLIA NUMBER - CLE ELUM - ROSLYN SCHOOL DISTRICT

Laboratory Demographics

CLIA Number: 50D2299641

Facility Name: CLE ELUM - ROSLYN SCHOOL DISTRICT

Facility Address:
4244 BULLFROG RD
CLE ELUM, WA
ZIP 98922
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Facility Phone Number: 509 649-4900

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1578847620

Taxonomy: 305R00000X - Preferred Provider Organization
A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.

CLIA Record

Field Name	Field Value
CLIA Number	50D2299641
LAB Type	School/Student Health Service
Facility Name	CLE ELUM - ROSLYN SCHOOL DISTRICT
Street	4244 BULLFROG RD
City	CLE ELUM
State	WA
ZIP	98922
Phone	509 649-4900
CertificateType	4
CertificateEffectiveDate	2/23/2024
CertificateExpirationDate	4/4/2028
FacilityType	Waiver

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