CLIA lab
CLIA 05D2169110: Adventist Health Medical Office
Clearlake, CA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 05D2169110 belongs to Adventist Health Medical Office in Clearlake, CA.
Certificate of Waiver, effective July 16, 2025, expires July 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 of Waiver
- Certificate effective
- July 16, 2025
- Certificate expiration
- July 15, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- July 16, 2019
- Facility type
- Rural health clinic
- Ownership (control type)
- Other
- Lab classification
- CLIA laboratory
- Directly affiliated labs
- 5
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 05D2169110
- Lab name
- Adventist Health Medical Office
- Additional name
- - Hilltop #102
- Address
- 15322 Lakeshore Dr, Clearlake, CA 95422
- Phone
- (707) 995-5778
Annual test volume the lab reported
- Waived tests
- 1,000
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Affiliated CLIA numbers
Other labs in Clearlake, CA
- Adventist Health Clear LakeCertificate of Accreditation, Hospital05D0611927
- Adventist Health Clear Lake Medical CTR -Certificate of Waiver, Other05D2037435
- Adventist Health Clear Lake Medical OfficeCertificate for Provider-Performed Microscopy Procedures, Rural health clinic05D0901413
- Adventist Health Medical Office - Hilltop # 103Certificate of Waiver, Rural health clinic05D2286726
- Adventist Health Medical Office - Hilltop #101Certificate of Waiver, Rural health clinic05D2289609
- Clearlake VA CbocCertificate of Accreditation, Community clinic05D2017138
- Eye Associates Medical Group IncCertificate of Compliance, Physician office05D1092687
- Walmart Pharmacy #10-1979Certificate of Waiver, Pharmacy05D2338981
Related
Questions
What is the CLIA number for Adventist Health Medical Office in Clearlake?
05D2169110, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Adventist Health Medical Office hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 05D2169110 expire?
The CMS file lists July 15, 2027 as the certificate expiration date; the certificate took effect July 16, 2025.