03D2296999 CLIA NUMBER - PRESCOTT MEDICAL AND DERMATOLOGY GROUP

Laboratory Demographics

  • CLIA Code: 03D2296999
  • Facility Name: PRESCOTT MEDICAL AND DERMATOLOGY GROUP
  • Facility Address: 804 AINSWORTH DR STE 105
    PRESCOTT, AZ
    ZIP 86301
  • Facility Phone: 928 515-1155
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DEAN STOKES
  • NPI Number: 1568424315
  • Taxonomy: 247100000X - Radiologic Technologist

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CLIA Record

Field Name Field Value
CLIA Number 03D2296999
LAB Type Physician Office
Facility Name PRESCOTT MEDICAL AND DERMATOLOGY GROUP
Street 804 AINSWORTH DR STE 105
City PRESCOTT
State AZ
ZIP 86301
Phone 928 515-1155
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/9/2024
Certificate Expiration Date 1/8/2026
Facility Type Physician Office
Lab Director DEAN STOKES

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