03D1079849 CLIA NUMBER - BOUSE MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 03D1079849

Facility Name: BOUSE MEDICAL CLINIC

Facility Address:
44031 E PLOMOSA RD
BOUSE, AZ
ZIP 85325
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Facility Phone Number: 928 851-2177

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1235154147

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	03D1079849
LAB Type	Community Clinic
Facility Name	BOUSE MEDICAL CLINIC
Street	44031 E PLOMOSA RD
City	BOUSE
State	AZ
ZIP	85325
Phone	928 851-2177
CertificateType	4
CertificateEffectiveDate	2/7/2024
CertificateExpirationDate	2/6/2026
FacilityType	Waiver

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