03D2074170 CLIA NUMBER - BENNETT CLINIC

Laboratory Demographics

  • CLIA Code: 03D2074170
  • Facility Name: BENNETT CLINIC
  • Facility Address: 3191 STILLWATER DR STE B
    PRESCOTT, AZ
    ZIP 86305
  • Facility Phone: 928 771-9400
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: WAYNE BENNETT
  • NPI Number: 1083946586
  • Taxonomy: 261QP2000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2074170
LAB Type Practitioner Other
Facility Name BENNETT CLINIC
Street 3191 STILLWATER DR STE B
City PRESCOTT
State AZ
ZIP 86305
Phone 928 771-9400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/3/2024
Certificate Expiration Date 3/2/2026
Facility Type Practitioner Other
Lab Director WAYNE BENNETT

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