03D2026773 CLIA NUMBER - PONDEROSA FAMILY CARE

Laboratory Demographics

  • CLIA Code: 03D2026773
  • Facility Name: PONDEROSA FAMILY CARE
  • Facility Address: 806 S PONDEROSA
    PAYSON, AZ
    ZIP 85541
  • Facility Phone: 928 468-8603
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALAN P. MICHELS
  • NPI Number: 1992321723
  • Taxonomy: 261QR1300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 03D2026773
LAB Type Physician Office
Facility Name PONDEROSA FAMILY CARE
Street 806 S PONDEROSA
City PAYSON
State AZ
ZIP 85541
Phone 928 468-8603
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/8/2023
Certificate Expiration Date 7/7/2025
Facility Type Physician Office
Lab Director ALAN P. MICHELS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 3/20/2025