03D2154549 CLIA NUMBER - OPTUM PRIMARY CARE - COTTONWOOD

Laboratory Demographics

  • CLIA Code: 03D2154549
  • Facility Name: OPTUM PRIMARY CARE - COTTONWOOD
  • Facility Address: 203 S CANDY LN STE 13AB
    COTTONWOOD, AZ
    ZIP 86326
  • Facility Phone: 928 649-1389
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: TARA OSTROM
  • NPI Number: 1700247509
  • Taxonomy: 363LF0000X - Nurse Practitioner

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 03D2154549
LAB Type Practitioner Other
Facility Name OPTUM PRIMARY CARE - COTTONWOOD
Street 203 S CANDY LN STE 13AB
City COTTONWOOD
State AZ
ZIP 86326
Phone 928 649-1389
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/14/2024
Certificate Expiration Date 9/13/2026
Facility Type Practitioner Other
Lab Director TARA OSTROM

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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