03D1027556 CLIA NUMBER - AKDHC - PRESCOTT

Laboratory Demographics

CLIA Number: 03D1027556

Facility Name: AKDHC - PRESCOTT

Facility Address:
3122 WILLOW CREEK RD
PRESCOTT, AZ
ZIP 86301
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Facility Phone Number: 928 445-7632

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1306380993

Taxonomy: 207RN0300X - Internal Medicine
An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

CLIA Record

Field Name	Field Value
CLIA Number	03D1027556
LAB Type	Physician Office
Facility Name	AKDHC - PRESCOTT
Street	3122 WILLOW CREEK RD
City	PRESCOTT
State	AZ
ZIP	86301
Phone	928 445-7632
CertificateType	3
CertificateEffectiveDate	2/28/2023
CertificateExpirationDate	2/27/2025
FacilityType	PPMP

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