03D2121067 CLIA NUMBER - BANNER-UNIVERSITY MEDICAL GROUP LLC

Laboratory Demographics

  • CLIA Code: 03D2121067
  • Facility Name: BANNER-UNIVERSITY MEDICAL GROUP LLC
  • Facility Address: 3838 N CAMPBELL AVE BLDG 2
    TUCSON, AZ
    ZIP 85719
  • Facility Phone: 520 694-1021
  • Facility Type: Other - HOSPITAL LOCATION
  • Facility Type: Microscopy
  • Lab Director: VENKATA EVANI
  • NPI Number: 1265820179
  • Taxonomy: 282N00000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 03D2121067
LAB Type Other - HOSPITAL LOCATION
Facility Name BANNER-UNIVERSITY MEDICAL GROUP LLC
Street 3838 N CAMPBELL AVE BLDG 2
City TUCSON
State AZ
ZIP 85719
Phone 520 694-1021
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/28/2024
Certificate Expiration Date 10/27/2026
Facility Type Other - HOSPITAL LOCATION
Lab Director VENKATA EVANI

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