03D0917901 CLIA NUMBER - KACHINA FAMILY PRACTICE PA

Laboratory Demographics

  • CLIA Code: 03D0917901
  • Facility Name: KACHINA FAMILY PRACTICE PA
  • Facility Address: 16611 S 40TH ST STE 120
    PHOENIX, AZ
    ZIP 85048
  • Facility Phone: 480 706-4100
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JARON J. FISCHBECK
  • NPI Number: 1467508432
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D0917901
LAB Type Physician Office
Facility Name KACHINA FAMILY PRACTICE PA
Street 16611 S 40TH ST STE 120
City PHOENIX
State AZ
ZIP 85048
Phone 480 706-4100
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 12/1/2023
Certificate Expiration Date 11/30/2025
Facility Type Physician Office
Lab Director JARON J. FISCHBECK

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This page was last updated on: 6/4/2025