03D2002603 CLIA NUMBER - PHOENIX SPINE GOODYEAR ASC, LLC

Laboratory Demographics

  • CLIA Code: 03D2002603
  • Facility Name: PHOENIX SPINE GOODYEAR ASC, LLC
  • Facility Address: 140 N LITCHFIELD RD STE 110
    GOODYEAR, AZ
    ZIP 85338
  • Facility Phone: 402 709-3827
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RICHARD K. BASSETT
  • NPI Number: 1477098432
  • Taxonomy: 207T00000X - Neurological Surgery

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CLIA Record

Field Name Field Value
CLIA Number 03D2002603
LAB Type Physician Office
Facility Name PHOENIX SPINE GOODYEAR ASC, LLC
Street 140 N LITCHFIELD RD STE 110
City GOODYEAR
State AZ
ZIP 85338
Phone 402 709-3827
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/21/2024
Certificate Expiration Date 1/20/2026
Facility Type Physician Office
Lab Director RICHARD K. BASSETT

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