03D2024361 CLIA NUMBER - STOUT WELLNESS CENTER

Laboratory Demographics

  • CLIA Code: 03D2024361
  • Facility Name: STOUT WELLNESS CENTER
  • Facility Address: 5130 S HWY 95
    FORT MOHAVE, AZ
    ZIP 86426
  • Facility Phone: 928 768-2811
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TERRY L. COYLE
  • NPI Number: 1518082122
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2024361
LAB Type Physician Office
Facility Name STOUT WELLNESS CENTER
Street 5130 S HWY 95
City FORT MOHAVE
State AZ
ZIP 86426
Phone 928 768-2811
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/13/2025
Certificate Expiration Date 5/12/2027
Facility Type Physician Office
Lab Director TERRY L. COYLE

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