CLIA lab
CLIA 05D0860685: Providence Family Practice
Fortuna, CA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 05D0860685 belongs to Providence Family Practice in Fortuna, CA.
Certificate of Waiver, effective January 22, 2026, expires January 21, 2028.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- January 22, 2026
- Certificate expiration
- January 21, 2028
- 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
- 05D0860685
- Lab name
- Providence Family Practice
- Address
- 3302 Renner Dr, Fortuna, CA 95540
- Phone
- (707) 725-3318
- Fax
- (707) 725-9396
Annual test volume the lab reported
- Waived tests
- 450
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Fortuna, CA
- Fortuna Community Health CenterCertificate for Provider-Performed Microscopy Procedures, Federally qualified health center05D2105027
- Fortuna Family Medicine IncCertificate for Provider-Performed Microscopy Procedures, Rural health clinic05D2284904
- Fortuna Pharmacy IncCertificate of Waiver, Pharmacy05D2316599
- Fortuna RehabilitationCertificate of Waiver, Skilled nursing or nursing facility05D2027526
- Ikigai Physician GroupCertificate of Waiver, Physician office05D2266217
- Providence Redwood Memorial Hospital LaboratoryCertificate of Accreditation, Hospital05D0613039
- Redwood Coast PaceCertificate of Waiver, Other05D2183480
- Redwood Pediatric Medical GroupCertificate of Waiver, Physician office05D0613017
Related
Questions
What is the CLIA number for Providence Family Practice in Fortuna?
05D0860685, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Providence Family Practice hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 05D0860685 expire?
The CMS file lists January 21, 2028 as the certificate expiration date; the certificate took effect January 22, 2026.