03D2130701 CLIA NUMBER - Sycamore Avenue Medical Center, Pllc

Laboratory Demographics

CLIA Number: 03D2130701

Facility Name: Sycamore Avenue Medical Center, Pllc

Facility Address:
975 Sycamaore Ave
Kingman, AZ
ZIP 86409
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Facility Phone Number: (928) 692-1900

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1245762491

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name Field Value
CLIA Number 03D2130701
LAB Type PHYSICIAN OFFICE
Facility Name Sycamore Avenue Medical Center, Pllc
Street 975 Sycamaore Ave
City Kingman
State AZ
ZIP 86409
Phone (928) 692-1900

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This page was last updated on: 4/7/2021