03D2123901 CLIA NUMBER - BANNER PHYSICIAN SPECIALISTS ARIZONA LLC

Laboratory Demographics

CLIA Number: 03D2123901

Facility Name: BANNER PHYSICIAN SPECIALISTS ARIZONA LLC

Facility Address:
37100 N GANTZEL RD STE 201
QUEEN CREEK, AZ
ZIP 85140
Get Directions

Facility Phone Number: 480 394-4469

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1316228802

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2123901
LAB Type	Physician Office
Facility Name	BANNER PHYSICIAN SPECIALISTS ARIZONA LLC
Street	37100 N GANTZEL RD STE 201
City	QUEEN CREEK
State	AZ
ZIP	85140
Phone	480 394-4469
CertificateType	3
CertificateEffectiveDate	1/5/2023
CertificateExpirationDate	1/4/2025
FacilityType	PPMP

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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