03D2296647 CLIA NUMBER - BANNER OCCUPATIONAL HEALTH-ARIZONA

Laboratory Demographics

CLIA Number: 03D2296647

Facility Name: BANNER OCCUPATIONAL HEALTH-ARIZONA

Facility Address:
1641 E GUADALUPE RD
EHRENBERG, AZ
ZIP 85334
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Facility Phone Number: 480 543-3300

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1669015467

Taxonomy: 261QX0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2296647
LAB Type	Physician Office
Facility Name	BANNER OCCUPATIONAL HEALTH-ARIZONA
Street	1641 E GUADALUPE RD
City	EHRENBERG
State	AZ
ZIP	85334
Phone	480 543-3300
CertificateType	4
CertificateEffectiveDate	1/3/2024
CertificateExpirationDate	1/2/2026
FacilityType	Waiver

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