03D2296432 CLIA NUMBER - SOUTHWEST SKIN SPECIALISTS LLC DBA DBA BEATRICE KELLER CLINIC

Laboratory Demographics

  • CLIA Code: 03D2296432
  • Facility Name: SOUTHWEST SKIN SPECIALISTS LLC DBA DBA BEATRICE KELLER CLINIC
  • Facility Address: 13943 N 91ST AVE BLDG C-101
    PEORIA, AZ
    ZIP 85381
  • Facility Phone: 623 972-3992
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: TROY C. ELLIS
  • NPI Number: 1689769143
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 03D2296432
LAB Type Physician Office
Facility Name SOUTHWEST SKIN SPECIALISTS LLC DBA DBA BEATRICE KELLER CLINIC
Street 13943 N 91ST AVE BLDG C-101
City PEORIA
State AZ
ZIP 85381
Phone 623 972-3992
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 12/28/2023
Certificate Expiration Date 12/27/2025
Facility Type Physician Office
Lab Director TROY C. ELLIS

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