03D2293660 CLIA NUMBER - CREEKSIDE BIRTH COTTAGE

Laboratory Demographics

  • CLIA Code: 03D2293660
  • Facility Name: CREEKSIDE BIRTH COTTAGE
  • Facility Address: 215 W FRONTIER
    PAYSON, AZ
    ZIP 85541
  • Facility Phone: 928 951-6410
  • Facility Type: Other - BIRTH CENTER
  • Facility Type: Waiver
  • Lab Director: LACEY TACKETT
  • NPI Number: 1679350698
  • Taxonomy: 176B00000X - Midwife

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CLIA Record

Field Name Field Value
CLIA Number 03D2293660
LAB Type Other - BIRTH CENTER
Facility Name CREEKSIDE BIRTH COTTAGE
Street 215 W FRONTIER
City PAYSON
State AZ
ZIP 85541
Phone 928 951-6410
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/13/2023
Certificate Expiration Date 11/12/2025
Facility Type Other - BIRTH CENTER
Lab Director LACEY TACKETT

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