03D2260941 CLIA NUMBER - WELLNESS 1ST INTEGRATIVE MEDICAL CENTER

Laboratory Demographics

CLIA Number: 03D2260941

Facility Name: WELLNESS 1ST INTEGRATIVE MEDICAL CENTER

Facility Address:
2451 E BASELINE RD STE 100
GILBERT, AZ
ZIP 85234
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Facility Phone Number: 480 304-5152

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1053825364

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	03D2260941
LAB Type	Physician Office
Facility Name	WELLNESS 1ST INTEGRATIVE MEDICAL CENTER
Street	2451 E BASELINE RD STE 100
City	GILBERT
State	AZ
ZIP	85234
Phone	480 304-5152
CertificateType	4
CertificateEffectiveDate	5/24/2022
CertificateExpirationDate	5/23/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024