03D2001285 CLIA NUMBER - PHOENIX SKIN MEDICAL SURGICAL GROUP

Laboratory Demographics

  • CLIA Code: 03D2001285
  • Facility Name: PHOENIX SKIN MEDICAL SURGICAL GROUP
  • Facility Address: 5056 N CENTRAL AVENUE
    PHOENIX, AZ
    ZIP 85012
  • Facility Phone: 602 222-9111
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: NICHELLE K. MADDEN
  • NPI Number: 1609078997
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 03D2001285
LAB Type Physician Office
Facility Name PHOENIX SKIN MEDICAL SURGICAL GROUP
Street 5056 N CENTRAL AVENUE
City PHOENIX
State AZ
ZIP 85012
Phone 602 222-9111
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 3/9/2025
Certificate Expiration Date 3/8/2027
Facility Type Physician Office
Lab Director NICHELLE K. MADDEN

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