03D0865172 CLIA NUMBER - NORTH PHOENIX INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 03D0865172
  • Facility Name: NORTH PHOENIX INTERNAL MEDICINE
  • Facility Address: 1747 E MORTEN STE 303
    PHOENIX, AZ
    ZIP 85020
  • Facility Phone: 602 589-0370
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: W KENT BRUBAKER MD
  • NPI Number: 1700850492
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D0865172
LAB Type Physician Office
Facility Name NORTH PHOENIX INTERNAL MEDICINE
Street 1747 E MORTEN STE 303
City PHOENIX
State AZ
ZIP 85020
Phone 602 589-0370
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director W KENT BRUBAKER MD

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