50D2322413 CLIA NUMBER - SELEVERSTOV MEDICAL PC

Laboratory Demographics

  • CLIA Code: 50D2322413
  • Facility Name: SELEVERSTOV MEDICAL PC
  • Facility Address: 56 N COLLEGE AVE UNIT 2A
    COLLEGE PLACE, WA
    ZIP 99324
  • Facility Phone: 509 730-0728
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: OLEKSANDR SELEVERSTOV
  • NPI Number: 1275215972
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 50D2322413
LAB Type Physician Office
Facility Name SELEVERSTOV MEDICAL PC
Street 56 N COLLEGE AVE UNIT 2A
City COLLEGE PLACE
State WA
ZIP 99324
Phone 509 730-0728
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/21/2025
Certificate Expiration Date 4/4/2028
Facility Type Physician Office
Lab Director OLEKSANDR SELEVERSTOV

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This page was last updated on: 9/29/2025