03D2106649 CLIA NUMBER - BANNER PHYSICIAN SPECIALISTS ARIZONA LLC

Laboratory Demographics

  • CLIA Code: 03D2106649
  • Facility Name: BANNER PHYSICIAN SPECIALISTS ARIZONA LLC
  • Facility Address: 21772 S ELLSWORTH LOOP RD
    QUEEN CREEK, AZ
    ZIP 85142
  • Facility Phone: 480 512-3700
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DARYN MCCLURE
  • NPI Number: 1629557913
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 03D2106649
LAB Type Physician Office
Facility Name BANNER PHYSICIAN SPECIALISTS ARIZONA LLC
Street 21772 S ELLSWORTH LOOP RD
City QUEEN CREEK
State AZ
ZIP 85142
Phone 480 512-3700
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/22/2023
Certificate Expiration Date 12/21/2025
Facility Type Physician Office
Lab Director DARYN MCCLURE

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