03D2117601 CLIA NUMBER - BANNER - UNIVERSITY SUPER SPECIALISTS LLC ADV LIVER DISEASE/TRANSPLANT

Laboratory Demographics

  • Code: 03D2117601
  • Facility Name: BANNER - UNIVERSITY SUPER SPECIALISTS LLC ADV LIVER DISEASE/TRANSPLANT
  • Facility Address: 1441 N 12TH ST, 2ND FLOOR
    PHOENIX, AZ
    ZIP 85006
  • Facility Phone: 602 521-2900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • NPI Number: 1205041126
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
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CLIA Record

Field Name Field Value
CLIA Number 03D2117601
LAB Type Physician Office
Facility Name BANNER - UNIVERSITY SUPER SPECIALISTS LLC ADV LIVER DISEASE/TRANSPLANT
Street 1441 N 12TH ST, 2ND FLOOR
City PHOENIX
State AZ
ZIP 85006
Phone 602 521-2900
Certificate Type 4
Certificate Effective Date 8/19/2022
Certificate Expiration Date 8/18/2024
Facility Type Waiver

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This page was last updated on: 4/23/2024