03D2325742 CLIA NUMBER - BANNER HEALTH

Laboratory Demographics

  • CLIA Code: 03D2325742
  • Facility Name: BANNER HEALTH
  • Facility Address: 680 E DEUCE OF CLUBS
    SHOW LOW, AZ
    ZIP 85901
  • Facility Phone: 928 596-4580
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEANNIE EVANS
  • NPI Number: 1942097993
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2325742
LAB Type Physician Office
Facility Name BANNER HEALTH
Street 680 E DEUCE OF CLUBS
City SHOW LOW
State AZ
ZIP 85901
Phone 928 596-4580
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

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