CLIA lab
CLIA 50D0634680: SRC - MT Vernon Clinic
Concrete, WA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 50D0634680 belongs to SRC - MT Vernon Clinic in Concrete, WA.
Certificate of Waiver, effective May 8, 2019, expires April 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
- May 8, 2019
- Certificate expiration
- April 4, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- December 16, 1992
- Facility type
- Community clinic
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA exempt 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
- 50D0634680
- Lab name
- SRC - MT Vernon Clinic
- Address
- 901 South 5th St, Concrete, WA 98237
- Phone
- (360) 428-2567
- Fax
- (360) 428-6486
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 Concrete, WA
Related
Questions
What is the CLIA number for SRC - MT Vernon Clinic in Concrete?
50D0634680, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does SRC - MT Vernon Clinic hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 50D0634680 expire?
The CMS file lists April 4, 2028 as the certificate expiration date; the certificate took effect May 8, 2019.