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: 5/11/2023