03D0937823 CLIA NUMBER - BANNER CHILDREN'S - BANNER HEALTH CLINIC

Laboratory Demographics

CLIA Number: 03D0937823

Facility Name: BANNER CHILDREN'S - BANNER HEALTH CLINIC

Facility Address:
1450 S DOBSON STE B220
MESA, AZ
ZIP 85202
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Facility Phone Number: 480 827-5044

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1679941637

Taxonomy: 282NC2000X - General Acute Care Hospital

CLIA Record

Field Name	Field Value
CLIA Number	03D0937823
LAB Type	Physician Office
Facility Name	BANNER CHILDREN'S - BANNER HEALTH CLINIC
Street	1450 S DOBSON STE B220
City	MESA
State	AZ
ZIP	85202
Phone	480 827-5044
CertificateType	4
CertificateEffectiveDate	1/16/2024
CertificateExpirationDate	1/15/2026
FacilityType	Waiver

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