03D2166612 CLIA NUMBER - OPTUM PRIMARY CARE - SAN TAN

Laboratory Demographics

CLIA Number: 03D2166612

Facility Name: OPTUM PRIMARY CARE - SAN TAN

Facility Address:
36283 N GANTZEL RD STE 101
SAN TAN VALLEY, AZ
ZIP 85140
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Facility Phone Number: 480 351-7277

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1497249452

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	03D2166612
LAB Type	Physician Office
Facility Name	OPTUM PRIMARY CARE - SAN TAN
Street	36283 N GANTZEL RD STE 101
City	SAN TAN VALLEY
State	AZ
ZIP	85140
Phone	480 351-7277
CertificateType	4
CertificateEffectiveDate	5/21/2023
CertificateExpirationDate	5/20/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024