03D2192886 CLIA NUMBER - HEART SHOP

Laboratory Demographics

  • CLIA Code: 03D2192886
  • Facility Name: HEART SHOP
  • Facility Address: 225 GROVE AVE
    PRESCOTT, AZ
    ZIP 86301
  • Facility Phone: 928 708-9355
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DOUGLAS W. ROTHROCK
  • NPI Number: 1558997742
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D2192886
LAB Type Physician Office
Facility Name HEART SHOP
Street 225 GROVE AVE
City PRESCOTT
State AZ
ZIP 86301
Phone 928 708-9355
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/15/2024
Certificate Expiration Date 9/14/2026
Facility Type Physician Office
Lab Director DOUGLAS W. ROTHROCK

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