03D2325741 CLIA NUMBER - BANNER HEALTH

Laboratory Demographics

  • CLIA Code: 03D2325741
  • Facility Name: BANNER HEALTH
  • Facility Address: 3457 W WHITE MOUNTAIN BLVD
    LAKESIDE, AZ
    ZIP 85929
  • Facility Phone: 928 358-1515
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEANNIE EVANS
  • NPI Number: 1275320327
  • Taxonomy: 261QR1300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 03D2325741
LAB Type Physician Office
Facility Name BANNER HEALTH
Street 3457 W WHITE MOUNTAIN BLVD
City LAKESIDE
State AZ
ZIP 85929
Phone 928 358-1515
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/19/2025
Certificate Expiration Date 6/18/2027
Facility Type Physician Office
Lab Director JEANNIE EVANS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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