03D2057384 CLIA NUMBER - BANNER - UNIVERSITY MEDICAL GROUP LLC

Laboratory Demographics

  • CLIA Code: 03D2057384
  • Facility Name: BANNER - UNIVERSITY MEDICAL GROUP LLC
  • Facility Address: 3950 S COUNTRY CLUB RD, STE 200
    TUCSON, AZ
    ZIP 85713
  • Facility Phone: 520 626-5813
  • Facility Type: Other - HOME BASED PRIMARY CARE
  • Facility Type: Waiver
  • Lab Director: DOROTHY TERRAZAS
  • NPI Number: 1063881688
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2057384
LAB Type Other - HOME BASED PRIMARY CARE
Facility Name BANNER - UNIVERSITY MEDICAL GROUP LLC
Street 3950 S COUNTRY CLUB RD, STE 200
City TUCSON
State AZ
ZIP 85713
Phone 520 626-5813
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/15/2025
Certificate Expiration Date 4/14/2027
Facility Type Other - HOME BASED PRIMARY CARE
Lab Director DOROTHY TERRAZAS

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