03D2096481 CLIA NUMBER - GILBERT CHILDRENS MEDICAL GROUP INC

Laboratory Demographics

  • CLIA Code: 03D2096481
  • Facility Name: GILBERT CHILDRENS MEDICAL GROUP INC
  • Facility Address: 4365 E PECOS RD STE 123
    GILBERT, AZ
    ZIP 85295
  • Facility Phone: 480 892-3880
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TIMOTHY L. JACKS
  • NPI Number: 1427211804
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 03D2096481
LAB Type Physician Office
Facility Name GILBERT CHILDRENS MEDICAL GROUP INC
Street 4365 E PECOS RD STE 123
City GILBERT
State AZ
ZIP 85295
Phone 480 892-3880
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/26/2023
Certificate Expiration Date 5/25/2025
Facility Type Physician Office
Lab Director TIMOTHY L. JACKS

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