03D2018487 CLIA NUMBER - WILDE DESERT FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 03D2018487
  • Facility Name: WILDE DESERT FAMILY MEDICINE
  • Facility Address: 302 EL CAMINO REAL BLDG 11 STE A
    SIERRA VISTA, AZ
    ZIP 85635
  • Facility Phone: 520 255-5475
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEFFREY WILDE
  • NPI Number: 1518515683
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D2018487
LAB Type Physician Office
Facility Name WILDE DESERT FAMILY MEDICINE
Street 302 EL CAMINO REAL BLDG 11 STE A
City SIERRA VISTA
State AZ
ZIP 85635
Phone 520 255-5475
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/6/2025
Certificate Expiration Date 1/5/2027
Facility Type Physician Office
Lab Director JEFFREY WILDE

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