03D1056192 CLIA NUMBER - MEGAN S K WIESE MD PC

Laboratory Demographics

  • CLIA Code: 03D1056192
  • Facility Name: MEGAN S K WIESE MD PC
  • Facility Address: 2130 MESQUITE AVE #106
    LAKE HAVASU CITY, AZ
    ZIP 86403
  • Facility Phone: 928 854-6249
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MEGAN S K WIESE MD
  • NPI Number: 1033394002
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 03D1056192
LAB Type Physician Office
Facility Name MEGAN S K WIESE MD PC
Street 2130 MESQUITE AVE #106
City LAKE HAVASU CITY
State AZ
ZIP 86403
Phone 928 854-6249
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 7/10/2024
Certificate Expiration Date 7/9/2026
Facility Type Physician Office
Lab Director MEGAN S K WIESE MD

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