03D2303254 CLIA NUMBER - PRESCOTT PROFESSIONAL HEALTHCARE, PLLC

Laboratory Demographics

  • CLIA Code: 03D2303254
  • Facility Name: PRESCOTT PROFESSIONAL HEALTHCARE, PLLC
  • Facility Address: 3195 STILLWATER DR STE B
    PRESCOTT, AZ
    ZIP 86305
  • Facility Phone: 928 515-2803
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DEANNA PRICE
  • NPI Number: 1275526402
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2303254
LAB Type Physician Office
Facility Name PRESCOTT PROFESSIONAL HEALTHCARE, PLLC
Street 3195 STILLWATER DR STE B
City PRESCOTT
State AZ
ZIP 86305
Phone 928 515-2803
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2024
Certificate Expiration Date 4/22/2026
Facility Type Physician Office
Lab Director DEANNA PRICE

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