03D2277823 CLIA NUMBER - BANNER HEALTH - BANNER HEALTH CLINIC PINE

Laboratory Demographics

  • CLIA Code: 03D2277823
  • Facility Name: BANNER HEALTH - BANNER HEALTH CLINIC PINE
  • Facility Address: 6152 HARDSCRABBLE RD
    PINE, AZ
    ZIP 85544
  • Facility Phone: 928 596-4848
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: TAMARA RECTOR
  • NPI Number: 1245940287
  • Taxonomy: 261QR1300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 03D2277823
LAB Type Rural Health Clinic
Facility Name BANNER HEALTH - BANNER HEALTH CLINIC PINE
Street 6152 HARDSCRABBLE RD
City PINE
State AZ
ZIP 85544
Phone 928 596-4848
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/6/2025
Certificate Expiration Date 3/5/2027
Facility Type Rural Health Clinic
Lab Director TAMARA RECTOR

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