03D2024966 CLIA NUMBER - 1ST FAMILY MEDICINE

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Laboratory Demographics

CLIA Number: 03D2024966

Facility Name: 1ST FAMILY MEDICINE

Facility Address:
1500 S WATSON RD, STE C-104
BUCKEYE, AZ
ZIP 85326
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Facility Phone Number: 623 251-7559

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1417286709

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2024966
LAB Type	Physician Office
Facility Name	1ST FAMILY MEDICINE
Street	1500 S WATSON RD, STE C-104
City	BUCKEYE
State	AZ
ZIP	85326
Phone	623 251-7559
CertificateType	4
CertificateEffectiveDate	5/27/2023
CertificateExpirationDate	5/26/2025
FacilityType	Waiver

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