03D2293248 CLIA NUMBER - WADDELL FAMILY CARE

Laboratory Demographics

CLIA Number: 03D2293248

Facility Name: WADDELL FAMILY CARE

Facility Address:
13755 N LITCHFIELD RD STE 105
SURPRISE, AZ
ZIP 85379
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Facility Phone Number: 623 248-7404

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1144974395

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2293248
LAB Type	Physician Office
Facility Name	WADDELL FAMILY CARE
Street	13755 N LITCHFIELD RD STE 105
City	SURPRISE
State	AZ
ZIP	85379
Phone	623 248-7404
CertificateType	4
CertificateEffectiveDate	11/6/2023
CertificateExpirationDate	11/5/2025
FacilityType	Waiver

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