03D2106882 CLIA NUMBER - SUMMIT HEALTHCARE OUTPATIENT PAVILION

Laboratory Demographics

CLIA Number: 03D2106882

Facility Name: SUMMIT HEALTHCARE OUTPATIENT PAVILION

Facility Address:
4951 S WHITE MTN BLVD, BLDG A, 3RD FLOOR POD 5
SHOW LOW, AZ
ZIP 85901
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Facility Phone Number: (928) 537-6700

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1063166999

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2106882
LAB Type	PHYSICIAN OFFICE
Facility Name	SUMMIT HEALTHCARE OUTPATIENT PAVILION
Street	4951 S WHITE MTN BLVD, BLDG A, 3RD FLOOR POD 5
City	SHOW LOW
State	AZ
ZIP	85901
Phone	(928) 537-6700

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This page was last updated on: 5/11/2023