03D1027556 CLIA NUMBER - AKDHC - PRESCOTT

Laboratory Demographics

  • CLIA Code: 03D1027556
  • Facility Name: AKDHC - PRESCOTT
  • Facility Address: 3122 WILLOW CREEK RD
    PRESCOTT, AZ
    ZIP 86301
  • Facility Phone: 928 445-7632
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ROMANITA D. NICA
  • NPI Number: 1306380993
  • Taxonomy: 207RN0300X - Internal Medicine

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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
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 2/28/2025
Certificate Expiration Date 2/27/2027
Facility Type Physician Office
Lab Director ROMANITA D. NICA

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