03D2123781 CLIA NUMBER - BANNER PHYSICIAN SPECIALISTS ARIZONA LLC

Laboratory Demographics

CLIA Number: 03D2123781

Facility Name: BANNER PHYSICIAN SPECIALISTS ARIZONA LLC

Facility Address:
4720 E GREENWAY RD
PHOENIX, AZ
ZIP 85032
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Facility Phone Number: 602 439-6000

Facility Type: Physician Office

Certificate Type: Waiver

CLIA Record

Field Name	Field Value
CLIA Number	03D2123781
LAB Type	Physician Office
Facility Name	BANNER PHYSICIAN SPECIALISTS ARIZONA LLC
Street	4720 E GREENWAY RD
City	PHOENIX
State	AZ
ZIP	85032
Phone	602 439-6000
CertificateType	4
CertificateEffectiveDate	1/3/2023
CertificateExpirationDate	1/2/2025
FacilityType	Waiver

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