03D0681803 CLIA NUMBER - PRESCOTT WOMEN'S CLINIC

Laboratory Demographics

CLIA Number: 03D0681803

Facility Name: PRESCOTT WOMEN'S CLINIC

Facility Address:
919 12TH PLACE SUITE 1
PRESCOTT, AZ
ZIP 86305
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Facility Phone Number: 928 778-4300

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1932283686

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	03D0681803
LAB Type	Physician Office
Facility Name	PRESCOTT WOMEN'S CLINIC
Street	919 12TH PLACE SUITE 1
City	PRESCOTT
State	AZ
ZIP	86305
Phone	928 778-4300
CertificateType	3
CertificateEffectiveDate	11/11/2022
CertificateExpirationDate	11/10/2024
FacilityType	PPMP

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This page was last updated on: 4/23/2024