03D2179363 CLIA NUMBER - EVOLUTION HEALTHCARE MANAGEMENT LLC

Laboratory Demographics

  • CLIA Code: 03D2179363
  • Facility Name: EVOLUTION HEALTHCARE MANAGEMENT LLC
  • Facility Address: 7615 E BASELINE RD STE 101
    MESA, AZ
    ZIP 85209
  • Facility Phone: 480 354-7878
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHINY S. THOMAS
  • NPI Number: 1770951980
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2179363
LAB Type Physician Office
Facility Name EVOLUTION HEALTHCARE MANAGEMENT LLC
Street 7615 E BASELINE RD STE 101
City MESA
State AZ
ZIP 85209
Phone 480 354-7878
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/21/2024
Certificate Expiration Date 2/20/2026
Facility Type Physician Office
Lab Director SHINY S. THOMAS

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