03D2132419 CLIA NUMBER - PATRIOT INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 03D2132419
  • Facility Name: PATRIOT INTERNAL MEDICINE
  • Facility Address: 6620 E CARONDELET DR
    TUCSON, AZ
    ZIP 85710
  • Facility Phone: 520 398-7079
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: HELENE P. HENAGER
  • NPI Number: 1093263188
  • Taxonomy: 363LA2200X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 03D2132419
LAB Type Physician Office
Facility Name PATRIOT INTERNAL MEDICINE
Street 6620 E CARONDELET DR
City TUCSON
State AZ
ZIP 85710
Phone 520 398-7079
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/19/2025
Certificate Expiration Date 6/18/2027
Facility Type Physician Office
Lab Director HELENE P. HENAGER

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