03D2221041 CLIA NUMBER - OPTUM PRIMARY CARE - IRON SPRINGS

Laboratory Demographics

  • CLIA Code: 03D2221041
  • Facility Name: OPTUM PRIMARY CARE - IRON SPRINGS
  • Facility Address: 1151 W IRON SPRINGS RD, STE F
    PRESCOTT, AZ
    ZIP 86305
  • Facility Phone: 928 612-2368
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TARA OSTROM
  • NPI Number: 1699724039
  • Taxonomy: 207Q00000X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 03D2221041
LAB Type Physician Office
Facility Name OPTUM PRIMARY CARE - IRON SPRINGS
Street 1151 W IRON SPRINGS RD, STE F
City PRESCOTT
State AZ
ZIP 86305
Phone 928 612-2368
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/16/2025
Certificate Expiration Date 4/15/2027
Facility Type Physician Office
Lab Director TARA OSTROM

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