03D1059537 CLIA NUMBER - SUMMIT HEALTHCARE FAMILY MEDICINE AT BISON RANCH

Laboratory Demographics

CLIA Number: 03D1059537

Facility Name: SUMMIT HEALTHCARE FAMILY MEDICINE AT BISON RANCH

Facility Address:
2352 QUARTER HORSE TRAIL
OVERGAARD, AZ
ZIP 85933
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Facility Phone Number: 928 535-3616

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1326549031

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	03D1059537
LAB Type	Community Clinic
Facility Name	SUMMIT HEALTHCARE FAMILY MEDICINE AT BISON RANCH
Street	2352 QUARTER HORSE TRAIL
City	OVERGAARD
State	AZ
ZIP	85933
Phone	928 535-3616
CertificateType	4
CertificateEffectiveDate	10/2/2022
CertificateExpirationDate	10/1/2024
FacilityType	Waiver

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