03D2216778 CLIA NUMBER - BANNER PHYSICIAN SPECIALISTS ARIZONA LLC

Laboratory Demographics

  • CLIA Code: 03D2216778
  • Facility Name: BANNER PHYSICIAN SPECIALISTS ARIZONA LLC
  • Facility Address: 7701 W ASPERA BLVD STE 102, 201, 301
    GLENDALE, AZ
    ZIP 85308
  • Facility Phone: 623 248-2100
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: MICHELLE BALLECER
  • NPI Number: 1093216624
  • Taxonomy: 261QR0400X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 03D2216778
LAB Type Community Clinic
Facility Name BANNER PHYSICIAN SPECIALISTS ARIZONA LLC
Street 7701 W ASPERA BLVD STE 102, 201, 301
City GLENDALE
State AZ
ZIP 85308
Phone 623 248-2100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/16/2025
Certificate Expiration Date 3/15/2027
Facility Type Community Clinic
Lab Director MICHELLE BALLECER

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