CLIA lab
CLIA 50D0976109: 104th Avenue Medical Clinic Inc
Kent, WA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 50D0976109 belongs to 104th Avenue Medical Clinic Inc in Kent, WA.
Certificate of Waiver, effective January 28, 2010, 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
- January 28, 2010
- Certificate expiration
- April 4, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- July 25, 2000
- Facility type
- Physician office
- Ownership (control type)
- Unknown
- Lab classification
- CLIA exempt laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 50D0976109
- Lab name
- 104th Avenue Medical Clinic Inc
- Address
- 24604 104th Ave SE Ste 202, Kent, WA 98030
- Phone
- (253) 859-8371
- Fax
- (253) 859-9593
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Related
Questions
What is the CLIA number for 104th Avenue Medical Clinic Inc in Kent?
50D0976109, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does 104th Avenue Medical Clinic Inc hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 50D0976109 expire?
The CMS file lists April 4, 2028 as the certificate expiration date; the certificate took effect January 28, 2010.