CLIA lab
CLIA 05D0604964: Providence Medical Foundation Washington Primary
Petaluma, CA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 05D0604964 belongs to Providence Medical Foundation Washington Primary in Petaluma, CA.
Certificate for Provider-Performed Microscopy Procedures, effective July 20, 2024, expiration date July 19, 2026.
The CMS file posted October 16, 2026 lists the certificate as active, but its expiration date has passed. A renewal may not be in this file yet.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate for Provider-Performed Microscopy Procedures
- Certificate effective
- July 20, 2024
- Certificate expiration
- July 19, 2026
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- September 1, 1992
- Facility type
- Physician office
- Ownership (control type)
- Religious affiliation
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 05D0604964
- Lab name
- Providence Medical Foundation Washington Primary
- Additional name
- Care
- Address
- 905 E Washington St, Petaluma, CA 94952
- Phone
- (707) 763-9891
- Fax
- (707) 762-2311
Annual test volume the lab reported
- Waived tests
- 750
- Provider-performed microscopy tests
- 250
- Total
- 1,000
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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- Accentcare Home Health of CaCertificate of Waiver, Home health agency05D2010775
- Attenda Medical GroupCertificate of Waiver, Physician office05D2169114
- Bridge Home Health East Bay LLCCertificate of Waiver, Home health agency05D2159896
- Continuum Care Hospice, LLCCertificate of Waiver, Hospice05D2155281
- David Chappell MD Medical CorporationCertificate of Waiver, Physician office05D0947611
- Dermatology Associates of the Bay AreaCertificate of Compliance, Physician office05D0691718
- Institute for Health Management, IncCertificate of Waiver, Physician office05D0868551
- Longhorn Ridge RecoveryCertificate of Waiver, Other05D2336124
- Muir Wood Adolescent and Family ServicesCertificate of Waiver, Other05D2089303
- Muir Wood Adolescent and Family ServicesCertificate of Waiver, Ancillary test site05D2320127
Related
Questions
What is the CLIA number for Providence Medical Foundation Washington Primary in Petaluma?
05D0604964, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Providence Medical Foundation Washington Primary hold?
A Certificate for Provider-Performed Microscopy Procedures, according to the CMS file.
When does CLIA 05D0604964 expire?
The CMS file lists July 19, 2026 as the certificate expiration date; the certificate took effect July 20, 2024.