03D2111356 CLIA NUMBER - BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC

Laboratory Demographics

  • CLIA Code: 03D2111356
  • Facility Name: BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC
  • Facility Address: 5310 W THUNDERBIRD RD STE 310
    GLENDALE, AZ
    ZIP 85306
  • Facility Phone: 602 865-4470
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWARD CARTER
  • NPI Number: 1578125738
  • Taxonomy: 133NN1002X - Nutritionist

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CLIA Record

Field Name Field Value
CLIA Number 03D2111356
LAB Type Physician Office
Facility Name BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC
Street 5310 W THUNDERBIRD RD STE 310
City GLENDALE
State AZ
ZIP 85306
Phone 602 865-4470
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/5/2024
Certificate Expiration Date 4/4/2026
Facility Type Physician Office
Lab Director EDWARD CARTER

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