03D0967428 CLIA NUMBER - MIDWEST INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 03D0967428
  • Facility Name: MIDWEST INTERNAL MEDICINE
  • Facility Address: 1840 MESQUITE AVE STE B
    LAKE HAVASU CITY, AZ
    ZIP 86403
  • Facility Phone: 928 453-8500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANGELO M. ONG-VELOSO
  • NPI Number: 1619174604
  • Taxonomy: 174400000X - Specialist

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2025
Certificate Expiration Date 9/30/2027
Facility Type Physician Office
Lab Director ANGELO M. ONG-VELOSO

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