03D1039169 CLIA NUMBER - LA PAZ REGIONAL HOSPITAL DBA TRI-VALLEY MEDICAL CENTER

Laboratory Demographics

CLIA Number: 03D1039169

Facility Name: LA PAZ REGIONAL HOSPITAL DBA TRI-VALLEY MEDICAL CENTER

Facility Address:
39726 HARQUAHALA RD
SALOME, AZ
ZIP 85348
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Facility Phone Number: 928 859-3460

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1629093539

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D1039169
LAB Type	Community Clinic
Facility Name	LA PAZ REGIONAL HOSPITAL DBA TRI-VALLEY MEDICAL CENTER
Street	39726 HARQUAHALA RD
City	SALOME
State	AZ
ZIP	85348
Phone	928 859-3460
CertificateType	4
CertificateEffectiveDate	7/1/2023
CertificateExpirationDate	6/30/2025
FacilityType	Waiver

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