03D2011524 CLIA NUMBER - MACKENZIE DERMATOLOGY

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Laboratory Demographics

CLIA Number: 03D2011524

Facility Name: MACKENZIE DERMATOLOGY

Facility Address:
3190 CLEARWATER DR
PRESCOTT, AZ
ZIP 86305
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Facility Phone Number: 928 541-1312

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1396971958

Taxonomy: 207NS0135X - Dermatology
Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers).

CLIA Record

Field Name	Field Value
CLIA Number	03D2011524
LAB Type	Physician Office
Facility Name	MACKENZIE DERMATOLOGY
Street	3190 CLEARWATER DR
City	PRESCOTT
State	AZ
ZIP	86305
Phone	928 541-1312
CertificateType	2
CertificateEffectiveDate	10/29/2021
CertificateExpirationDate	4/30/2024
FacilityType	Compliance

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