03D2123342 CLIA NUMBER - BANNER URGENT CARE SERVICES LLC

Laboratory Demographics

CLIA Number: 03D2123342

Facility Name: BANNER URGENT CARE SERVICES LLC

Facility Address:
1908 E MCKELLIPS RD
MESA, AZ
ZIP 85203
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Facility Phone Number: 480 827-5610

Facility Type: Other - URGENT CARE

Certificate Type: Waiver

NPI Number: 1174095798

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2123342
LAB Type	Other - URGENT CARE
Facility Name	BANNER URGENT CARE SERVICES LLC
Street	1908 E MCKELLIPS RD
City	MESA
State	AZ
ZIP	85203
Phone	480 827-5610
CertificateType	4
CertificateEffectiveDate	12/19/2022
CertificateExpirationDate	12/18/2024
FacilityType	Waiver

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