50D0674902 CLIA NUMBER - PROVIDENCE PEDIATRIC ASSOCIATES MANITO

Laboratory Demographics

  • CLIA Code: 50D0674902
  • Facility Name: PROVIDENCE PEDIATRIC ASSOCIATES MANITO
  • Facility Address: 1919 S GRAND BLVD
    SPOKANE, WA
    ZIP 99203
  • Facility Phone: 509 944-8906
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LEDEL JAN RAMOS
  • NPI Number: 1952687386
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 50D0674902
LAB Type Physician Office
Facility Name PROVIDENCE PEDIATRIC ASSOCIATES MANITO
Street 1919 S GRAND BLVD
City SPOKANE
State WA
ZIP 99203
Phone 509 944-8906
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/1992
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: 3/20/2025