03D0967428 CLIA NUMBER - MIDWEST INTERNAL MEDICINE

Laboratory Demographics

CLIA Number: 03D0967428

Facility Name: MIDWEST INTERNAL MEDICINE

Facility Address:
1840 MESQUITE AVE STE B
LAKE HAVASU CITY, AZ
ZIP 86403
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Facility Phone Number: 928 453-8500

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1619174604

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	03D0967428
LAB Type	Physician Office
Facility Name	MIDWEST INTERNAL MEDICINE
Street	1840 MESQUITE AVE STE B
City	LAKE HAVASU CITY
State	AZ
ZIP	86403
Phone	928 453-8500
CertificateType	4
CertificateEffectiveDate	10/1/2023
CertificateExpirationDate	9/30/2025
FacilityType	Waiver

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