03D2303061 CLIA NUMBER - PREMIER MOUNTAIN IMAGING

Laboratory Demographics

  • CLIA Code: 03D2303061
  • Facility Name: PREMIER MOUNTAIN IMAGING
  • Facility Address: 5448 S HIGHWAY 260 STE 110
    LAKESIDE, AZ
    ZIP 85929
  • Facility Phone: 928 216-5250
  • Facility Type: Other - OP RADIOLOGY CLINIC
  • Facility Type: Waiver
  • Lab Director: ROSS MCARTHUR
  • NPI Number: 1184302002
  • Taxonomy: 261QM1200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2303061
LAB Type Other - OP RADIOLOGY CLINIC
Facility Name PREMIER MOUNTAIN IMAGING
Street 5448 S HIGHWAY 260 STE 110
City LAKESIDE
State AZ
ZIP 85929
Phone 928 216-5250
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/19/2024
Certificate Expiration Date 4/18/2026
Facility Type Other - OP RADIOLOGY CLINIC
Lab Director ROSS MCARTHUR

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