03D1079179 CLIA NUMBER - OPTUM PRIMARY CARE-SCOTTSDALE/SHEA

Laboratory Demographics

  • CLIA Code: 03D1079179
  • Facility Name: OPTUM PRIMARY CARE-SCOTTSDALE/SHEA
  • Facility Address: 9590 E IRONWOOD SQUARE DR, STE 125
    SCOTTSDALE, AZ
    ZIP 85258
  • Facility Phone: 480 455-3000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TARA OSTROM
  • NPI Number: 1558654384
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D1079179
LAB Type Physician Office
Facility Name OPTUM PRIMARY CARE-SCOTTSDALE/SHEA
Street 9590 E IRONWOOD SQUARE DR, STE 125
City SCOTTSDALE
State AZ
ZIP 85258
Phone 480 455-3000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2024
Certificate Expiration Date 1/24/2026
Facility Type Physician Office
Lab Director TARA OSTROM

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