03D2114233 CLIA NUMBER - PRESCOTT HEALTHCARE SOLUTIONS LLC DBA OPTIMA MEDICAL

Laboratory Demographics

  • CLIA Code: 03D2114233
  • Facility Name: PRESCOTT HEALTHCARE SOLUTIONS LLC DBA OPTIMA MEDICAL
  • Facility Address: 12361 W BOLA DR STE 109
    SURPRISE, AZ
    ZIP 85378
  • Facility Phone: 623 227-1000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GABRIELLE HANCOCK
  • NPI Number: 1235701327
  • Taxonomy: 207R00000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 03D2114233
LAB Type Physician Office
Facility Name PRESCOTT HEALTHCARE SOLUTIONS LLC DBA OPTIMA MEDICAL
Street 12361 W BOLA DR STE 109
City SURPRISE
State AZ
ZIP 85378
Phone 623 227-1000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/9/2024
Certificate Expiration Date 6/8/2026
Facility Type Physician Office
Lab Director GABRIELLE HANCOCK

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 6/4/2025