03D2142579 CLIA NUMBER - MOUNTAIN MEDICINE INTEGRATIVE WELLNESS CENTER

Laboratory Demographics

  • CLIA Code: 03D2142579
  • Facility Name: MOUNTAIN MEDICINE INTEGRATIVE WELLNESS CENTER
  • Facility Address: 1585 S PLAZA WAY STE 150
    FLAGSTAFF, AZ
    ZIP 86001
  • Facility Phone: 928 226-1556
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRET B. WOJCIAK
  • NPI Number: 1124640131
  • Taxonomy: 261QP2000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2142579
LAB Type Physician Office
Facility Name MOUNTAIN MEDICINE INTEGRATIVE WELLNESS CENTER
Street 1585 S PLAZA WAY STE 150
City FLAGSTAFF
State AZ
ZIP 86001
Phone 928 226-1556
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/16/2024
Certificate Expiration Date 1/15/2026
Facility Type Physician Office
Lab Director BRET B. WOJCIAK

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This page was last updated on: 9/29/2025