03D2284875 CLIA NUMBER - PEAKS PRIMARY CARE, THE

Laboratory Demographics

  • CLIA Code: 03D2284875
  • Facility Name: PEAKS PRIMARY CARE, THE
  • Facility Address: 919 12TH PLACE STE 5
    PRESCOTT, AZ
    ZIP 86305
  • Facility Phone: 302 820-8094
  • Facility Type: Other - PRIMARY CARE
  • Facility Type: Waiver
  • Lab Director: TERI L. ELLERBE
  • NPI Number: 1700583879
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 03D2284875
LAB Type Other - PRIMARY CARE
Facility Name PEAKS PRIMARY CARE, THE
Street 919 12TH PLACE STE 5
City PRESCOTT
State AZ
ZIP 86305
Phone 302 820-8094
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/29/2025
Certificate Expiration Date 6/28/2027
Facility Type Other - PRIMARY CARE
Lab Director TERI L. ELLERBE

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