03D2106068 CLIA NUMBER - FOUR PEAKS HEALTHCARE ASSOCIATES, PLLC

Laboratory Demographics

CLIA Number: 03D2106068

Facility Name: FOUR PEAKS HEALTHCARE ASSOCIATES, PLLC

Facility Address:
1515 E CEDAR AVE, SUITE C1
FLAGSTAFF, AZ
ZIP 86004
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Facility Phone Number: 928 773-9714

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1720450232

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2106068
LAB Type	Practitioner Other
Facility Name	FOUR PEAKS HEALTHCARE ASSOCIATES, PLLC
Street	1515 E CEDAR AVE, SUITE C1
City	FLAGSTAFF
State	AZ
ZIP	86004
Phone	928 773-9714
CertificateType	4
CertificateEffectiveDate	12/9/2023
CertificateExpirationDate	12/8/2025
FacilityType	Waiver

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