03D1070612 CLIA NUMBER - MAIN STREET FAMILY MEDICAL

Laboratory Demographics

CLIA Number: 03D1070612

Facility Name: MAIN STREET FAMILY MEDICAL

Facility Address:
118 WEST 5TH STREET
SAFFORD, AZ
ZIP 85546
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Facility Phone Number: 928 348-7100

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1386837763

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D1070612
LAB Type	Physician Office
Facility Name	MAIN STREET FAMILY MEDICAL
Street	118 WEST 5TH STREET
City	SAFFORD
State	AZ
ZIP	85546
Phone	928 348-7100
CertificateType	3
CertificateEffectiveDate	7/3/2023
CertificateExpirationDate	7/2/2025
FacilityType	PPMP

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