CLIA lab
CLIA 05D2069763: Pine Street Clinic
Mount Shasta, CA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 05D2069763 belongs to Pine Street Clinic in Mount Shasta, CA.
Certificate of Waiver, effective June 5, 2026, expires June 4, 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
- June 5, 2026
- Certificate expiration
- June 4, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- December 3, 2013
- Facility type
- Community clinic
- Ownership (control type)
- Religious affiliation
- 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
- 05D2069763
- Lab name
- Pine Street Clinic
- Address
- 408 Pine St, Mount Shasta, CA 96067
- Phone
- (530) 926-9334
Annual test volume the lab reported
- Waived tests
- 427
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Affiliated CLIA numbers
Other labs in Mount Shasta, CA
- Mercy MT Shasta Community ClinicCertificate for Provider-Performed Microscopy Procedures, Community clinic05D0683237
- Mercy Medical Center Mount ShastaCertificate of Accreditation, Hospital05D0618411
- Michael Staszel, DOCertificate of Waiver, Physician office05D2182495
- Shasta Family CareCertificate for Provider-Performed Microscopy Procedures, Physician office05D0922830
Related
Questions
What is the CLIA number for Pine Street Clinic in Mount Shasta?
05D2069763, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Pine Street Clinic hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 05D2069763 expire?
The CMS file lists June 4, 2028 as the certificate expiration date; the certificate took effect June 5, 2026.