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03D1096756 CLIA NUMBER - BANNER - UNIVERSITY PHYSICIAN SPECIALISTS LLC WOMEN'S

Laboratory Demographics

CLIA Number: 03D1096756

Facility Name: BANNER - UNIVERSITY PHYSICIAN SPECIALISTS LLC WOMEN'S

Facility Address:
1441 N 12TH ST, 3RD FLOOR
PHOENIX, AZ
ZIP 85006
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Facility Phone Number: 602 521-4755

Facility Type: Other

Certificate Type: Microscopy
NPI Number: 1205041126

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name Field Value
CLIA Number 03D1096756
LAB Type Other
Facility Name BANNER - UNIVERSITY PHYSICIAN SPECIALISTS LLC WOMEN'S
Street 1441 N 12TH ST, 3RD FLOOR
City PHOENIX
State AZ
ZIP 85006
Phone 602 521-4755
CertificateType 3
CertificateEffectiveDate 3/11/2023
CertificateExpirationDate 3/10/2025
FacilityType PPMP

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