03D1100140 CLIA NUMBER - LITTLE CLINIC - BUCKEYE, THE

Laboratory Demographics

CLIA Number: 03D1100140

Facility Name: LITTLE CLINIC - BUCKEYE, THE

Facility Address:
1300 S WATSON ROAD
BUCKEYE, AZ
ZIP 85326
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Facility Phone Number: 615 425-4200

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1821483132

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	03D1100140
LAB Type	Other
Facility Name	LITTLE CLINIC - BUCKEYE, THE
Street	1300 S WATSON ROAD
City	BUCKEYE
State	AZ
ZIP	85326
Phone	615 425-4200
CertificateType	4
CertificateEffectiveDate	5/29/2023
CertificateExpirationDate	5/28/2025
FacilityType	Waiver

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