03D2278288 CLIA NUMBER - BANNER - UNIVERSITY PHYSICIANS SPECIALISTS LLC

Laboratory Demographics

  • CLIA Code: 03D2278288
  • Facility Name: BANNER - UNIVERSITY PHYSICIANS SPECIALISTS LLC
  • Facility Address: 4200 E CAMELBACK RD STE 104
    PHOENIX, AZ
    ZIP 85018
  • Facility Phone: 602 229-2110
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EVAN LEDERMAN
  • NPI Number: 1902017346
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2278288
LAB Type Physician Office
Facility Name BANNER - UNIVERSITY PHYSICIANS SPECIALISTS LLC
Street 4200 E CAMELBACK RD STE 104
City PHOENIX
State AZ
ZIP 85018
Phone 602 229-2110
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/14/2025
Certificate Expiration Date 3/13/2027
Facility Type Physician Office
Lab Director EVAN LEDERMAN

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