CLIA lab
CLIA 05D1097391: David M Tully-Smith, MD, A Medical Corporation
San Rafael, CA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 05D1097391 belongs to David M Tully-Smith, MD, A Medical Corporation in San Rafael, CA.
Certificate of Waiver, effective March 25, 2025, expires March 24, 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 of Waiver
- Certificate effective
- March 25, 2025
- Certificate expiration
- March 24, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- March 25, 2009
- Facility type
- Physician office
- Ownership (control type)
- Proprietary
- 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
- 05D1097391
- Lab name
- David M Tully-Smith, MD, A Medical Corporation
- Additional name
- DBA Mill Valley Medical
- Address
- 711 D Street, Suite 111, San Rafael, CA 94901
- Phone
- (415) 453-3030
- Fax
- (707) 544-2712
Annual test volume the lab reported
- Waived tests
- 1,500
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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Related
Questions
What is the CLIA number for David M Tully-Smith, MD, A Medical Corporation in San Rafael?
05D1097391, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does David M Tully-Smith, MD, A Medical Corporation hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 05D1097391 expire?
The CMS file lists March 24, 2027 as the certificate expiration date; the certificate took effect March 25, 2025.