02D1025900 CLIA NUMBER - HEART OF WILLOW MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 02D1025900
  • Facility Name: HEART OF WILLOW MEDICAL CLINIC
  • Facility Address: MILE 69,1 OLD PARKS HWY
    WILLOW, AK
    ZIP 99688
  • Facility Phone: 907 495-4362
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: JOSE PRIMO N. ANZILOTTI
  • NPI Number: 1982721981
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 02D1025900
LAB Type Community Clinic
Facility Name HEART OF WILLOW MEDICAL CLINIC
Street MILE 69,1 OLD PARKS HWY
City WILLOW
State AK
ZIP 99688
Phone 907 495-4362
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/20/2024
Certificate Expiration Date 5/19/2026
Facility Type Community Clinic
Lab Director JOSE PRIMO N. ANZILOTTI

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This page was last updated on: 9/29/2025