03D1067634 CLIA NUMBER - NORTHLAND CARES

Laboratory Demographics

  • CLIA Code: 03D1067634
  • Facility Name: NORTHLAND CARES
  • Facility Address: 3188 N WINDSONG DR STE A
    PRESCOTT VALLEY, AZ
    ZIP 86314
  • Facility Phone: 928 776-4612
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID KECKICH
  • NPI Number: 1033213053
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D1067634
LAB Type Physician Office
Facility Name NORTHLAND CARES
Street 3188 N WINDSONG DR STE A
City PRESCOTT VALLEY
State AZ
ZIP 86314
Phone 928 776-4612
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type Physician Office
Lab Director DAVID KECKICH

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