03D2111776 CLIA NUMBER - BANNER-UNIVERSITY SUPER SPECIALISTS LLC

Laboratory Demographics

CLIA Number: 03D2111776

Facility Name: BANNER-UNIVERSITY SUPER SPECIALISTS LLC

Facility Address:
755 E MCDOWELL RD
PHOENIX, AZ
ZIP 85006
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Facility Phone Number: (844) 242-4664

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1306154943

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2111776
LAB Type	PHYSICIAN OFFICE
Facility Name	BANNER-UNIVERSITY SUPER SPECIALISTS LLC
Street	755 E MCDOWELL RD
City	PHOENIX
State	AZ
ZIP	85006
Phone	(844) 242-4664

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