03D2012303 CLIA NUMBER - BILLY CREEK CLINIC

Laboratory Demographics

  • CLIA Code: 03D2012303
  • Facility Name: BILLY CREEK CLINIC
  • Facility Address: 43 W WHITE MTN BLVD
    LAKESIDE, AZ
    ZIP 85929
  • Facility Phone: 928 367-4040
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SEAN P. WILSON
  • NPI Number: 1679730493
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2012303
LAB Type Physician Office
Facility Name BILLY CREEK CLINIC
Street 43 W WHITE MTN BLVD
City LAKESIDE
State AZ
ZIP 85929
Phone 928 367-4040
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director SEAN P. WILSON

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