03D2000921 CLIA NUMBER - ST LUKE'S PEDIATRICS

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Laboratory Demographics

CLIA Number: 03D2000921

Facility Name: ST LUKE'S PEDIATRICS

Facility Address:
1310 N 24TH ST STE 150
PHOENIX, AZ
ZIP 85008
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Facility Phone Number: 602 254-0200

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1306078514

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2000921
LAB Type	Physician Office
Facility Name	ST LUKE'S PEDIATRICS
Street	1310 N 24TH ST STE 150
City	PHOENIX
State	AZ
ZIP	85008
Phone	602 254-0200
CertificateType	4
CertificateEffectiveDate	12/9/2023
CertificateExpirationDate	12/8/2025
FacilityType	Waiver

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