03D0717766 CLIA NUMBER - PRIVIA MEDICAL GROUP ARIZONA, LLC

Laboratory Demographics

  • CLIA Code: 03D0717766
  • Facility Name: PRIVIA MEDICAL GROUP ARIZONA, LLC
  • Facility Address: 5601 W EUGIE AVE STE 203
    GLENDALE, AZ
    ZIP 85304
  • Facility Phone: 623 931-2221
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: KENNETH SMITH
  • NPI Number: 1942396023
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D0717766
LAB Type Physician Office
Facility Name PRIVIA MEDICAL GROUP ARIZONA, LLC
Street 5601 W EUGIE AVE STE 203
City GLENDALE
State AZ
ZIP 85304
Phone 623 931-2221
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 4/1/2024
Certificate Expiration Date 3/31/2026
Facility Type Physician Office
Lab Director KENNETH SMITH

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