03D2202305 CLIA NUMBER - PRESCOTT HEALTH CLINIC

Laboratory Demographics

  • CLIA Code: 03D2202305
  • Facility Name: PRESCOTT HEALTH CLINIC
  • Facility Address: 1003 DIVISION ST STE 2
    PRESCOTT, AZ
    ZIP 86301
  • Facility Phone: 928 717-0724
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: REBECCA A. OLDANI
  • NPI Number: 1003292038
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 03D2202305
LAB Type Rural Health Clinic
Facility Name PRESCOTT HEALTH CLINIC
Street 1003 DIVISION ST STE 2
City PRESCOTT
State AZ
ZIP 86301
Phone 928 717-0724
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/25/2024
Certificate Expiration Date 11/24/2026
Facility Type Rural Health Clinic
Lab Director REBECCA A. OLDANI

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