03D1036557 CLIA NUMBER - IM SPECIALIST, INC

Laboratory Demographics

CLIA Number: 03D1036557

Facility Name: IM SPECIALIST, INC

Facility Address:
2737 W BASELINE RD, SUITE 24
TEMPE, AZ
ZIP 85283
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Facility Phone Number: 602 437-4800

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1134337710

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	03D1036557
LAB Type	Physician Office
Facility Name	IM SPECIALIST, INC
Street	2737 W BASELINE RD, SUITE 24
City	TEMPE
State	AZ
ZIP	85283
Phone	602 437-4800
CertificateType	4
CertificateEffectiveDate	2/4/2023
CertificateExpirationDate	2/3/2025
FacilityType	Waiver

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