03D2277824 CLIA NUMBER - BANNER HEALTH CLINIC

Laboratory Demographics

  • CLIA Code: 03D2277824
  • Facility Name: BANNER HEALTH CLINIC
  • Facility Address: 117 E MAIN ST STE A100
    PAYSON, AZ
    ZIP 85541
  • Facility Phone: 928 596-4500
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JAMES SCHOUTEN
  • NPI Number: 1073223012
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2277824
LAB Type Physician Office
Facility Name BANNER HEALTH CLINIC
Street 117 E MAIN ST STE A100
City PAYSON
State AZ
ZIP 85541
Phone 928 596-4500
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/1/2024
Certificate Expiration Date 7/31/2026
Facility Type Physician Office
Lab Director JAMES SCHOUTEN

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This page was last updated on: 9/29/2025