03D2042356 CLIA NUMBER - SPRINGFIELD MEDICAL, LLC

Laboratory Demographics

  • CLIA Code: 03D2042356
  • Facility Name: SPRINGFIELD MEDICAL, LLC
  • Facility Address: 36351 N GANTZEL RD STE 127
    SAN TAN VALLEY, AZ
    ZIP 85140
  • Facility Phone: 602 734-5509
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: OLADIJI G. VAUGHAN
  • NPI Number: 1093019150
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 03D2042356
LAB Type Practitioner Other
Facility Name SPRINGFIELD MEDICAL, LLC
Street 36351 N GANTZEL RD STE 127
City SAN TAN VALLEY
State AZ
ZIP 85140
Phone 602 734-5509
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/11/2024
Certificate Expiration Date 6/10/2026
Facility Type Practitioner Other
Lab Director OLADIJI G. VAUGHAN

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