03D2277308 CLIA NUMBER - SRP FACILITY, PLLC

Laboratory Demographics

CLIA Number: 03D2277308

Facility Name: SRP FACILITY, PLLC

Facility Address:
11030 N TATUM BLVD STE 101F
PHOENIX, AZ
ZIP 85028
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Facility Phone Number: 602 889-9880

Facility Type: Other - OUTPATIENT TREATMENT CENT

Certificate Type: Waiver

NPI Number: 1801189519

Taxonomy: 261QP3300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2277308
LAB Type	Other - OUTPATIENT TREATMENT CENT
Facility Name	SRP FACILITY, PLLC
Street	11030 N TATUM BLVD STE 101F
City	PHOENIX
State	AZ
ZIP	85028
Phone	602 889-9880
CertificateType	4
CertificateEffectiveDate	2/24/2023
CertificateExpirationDate	2/23/2025
FacilityType	Waiver

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