03D2035675 CLIA NUMBER - SUMMIT HEALTHCARE OUTPATIENT PAVILION OB/GYN

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Laboratory Demographics

CLIA Number: 03D2035675

Facility Name: SUMMIT HEALTHCARE OUTPATIENT PAVILION OB/GYN

Facility Address:
4951 S WHITE MTN BLVD, BLDG A 3RD FLOOR POD 3
SHOW LOW, AZ
ZIP 85901
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Facility Phone Number: 928 537-6700

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1063166999

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2035675
LAB Type	Physician Office
Facility Name	SUMMIT HEALTHCARE OUTPATIENT PAVILION OB/GYN
Street	4951 S WHITE MTN BLVD, BLDG A 3RD FLOOR POD 3
City	SHOW LOW
State	AZ
ZIP	85901
Phone	928 537-6700
CertificateType	3
CertificateEffectiveDate	1/23/2024
CertificateExpirationDate	1/22/2026
FacilityType	PPMP

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