CLIA lab
CLIA 05D0923269: Providence Medical Foundation
Petaluma, CA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 05D0923269 belongs to Providence Medical Foundation in Petaluma, CA.
Certificate for Provider-Performed Microscopy Procedures, effective September 16, 2025, expires September 15, 2027.
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 for Provider-Performed Microscopy Procedures
- Certificate effective
- September 16, 2025
- Certificate expiration
- September 15, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- December 18, 1996
- 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
- 05D0923269
- Lab name
- Providence Medical Foundation
- Address
- 1550 Professional Dr Ste 200, Petaluma, CA 94954
- Phone
- (707) 769-7403
- Fax
- (707) 769-0134
Annual test volume the lab reported
- Waived tests
- 750
- Provider-performed microscopy tests
- 500
- Total
- 1,250
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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- 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 in Petaluma?
05D0923269, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Providence Medical Foundation hold?
A Certificate for Provider-Performed Microscopy Procedures, according to the CMS file.
When does CLIA 05D0923269 expire?
The CMS file lists September 15, 2027 as the certificate expiration date; the certificate took effect September 16, 2025.