03D2125471 CLIA NUMBER - SMI IMAGING LLC DBA SIMONMED IMAGING

Laboratory Demographics

  • CLIA Code: 03D2125471
  • Facility Name: SMI IMAGING LLC DBA SIMONMED IMAGING
  • Facility Address: 790 GAIL GARDNER WAY
    PRESCOTT, AZ
    ZIP 86305
  • Facility Phone: 928 443-6591
  • Facility Type: Other - MED IMAGING
  • Facility Type: Waiver
  • Lab Director: HOWARD J. SIMON
  • NPI Number: 1124624093
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 03D2125471
LAB Type Other - MED IMAGING
Facility Name SMI IMAGING LLC DBA SIMONMED IMAGING
Street 790 GAIL GARDNER WAY
City PRESCOTT
State AZ
ZIP 86305
Phone 928 443-6591
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/7/2025
Certificate Expiration Date 2/6/2027
Facility Type Other - MED IMAGING
Lab Director HOWARD J. SIMON

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This page was last updated on: 6/4/2025