CLIA lab
CLIA 05D0866946: Adventist Health Clear Lake Medical Office
Kelseyville, CA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 05D0866946 belongs to Adventist Health Clear Lake Medical Office in Kelseyville, CA.
Certificate of Waiver, effective February 19, 2026, expires February 18, 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
- February 19, 2026
- Certificate expiration
- February 18, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- September 1, 1992
- Facility type
- Rural health clinic
- Ownership (control type)
- Other
- Lab classification
- CLIA laboratory
- Directly affiliated labs
- 1
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 05D0866946
- Lab name
- Adventist Health Clear Lake Medical Office
- Additional name
- #name?
- Address
- 5290 State St, Kelseyville, CA 95451
- Phone
- (707) 995-5778
- Fax
- (707) 995-5816
Annual test volume the lab reported
- Waived tests
- 10,000
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Affiliated CLIA numbers
Other labs in Kelseyville, CA
Related
Questions
What is the CLIA number for Adventist Health Clear Lake Medical Office in Kelseyville?
05D0866946, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Adventist Health Clear Lake Medical Office hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 05D0866946 expire?
The CMS file lists February 18, 2028 as the certificate expiration date; the certificate took effect February 19, 2026.