03D2008390 CLIA NUMBER - PALO VERDE INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 03D2008390
  • Facility Name: PALO VERDE INTERNAL MEDICINE
  • Facility Address: 1923 MCCULLOCH BLVD NORTH, STE 101
    LAKE HAVASU CITY, AZ
    ZIP 86403
  • Facility Phone: 928 208-4611
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HARRISON M. MCDONALD
  • NPI Number: 1033435599
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D2008390
LAB Type Physician Office
Facility Name PALO VERDE INTERNAL MEDICINE
Street 1923 MCCULLOCH BLVD NORTH, STE 101
City LAKE HAVASU CITY
State AZ
ZIP 86403
Phone 928 208-4611
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/9/2024
Certificate Expiration Date 6/8/2026
Facility Type Physician Office
Lab Director HARRISON M. MCDONALD

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