05D0588097 CLIA NUMBER - MAMMOTH HOSPITAL LABORATORY

Laboratory Demographics

CLIA Number: 05D0588097

Facility Name: MAMMOTH HOSPITAL LABORATORY

Facility Address:
85 SIERRA PARK RD
MAMMOTH LAKES, CA
ZIP 93546
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Facility Phone Number: (760) 924-4090

Facility Type: HOSPITAL

Certificate Type: Accreditation

NPI Number: 1962444059

Taxonomy: 261QC0050X - Clinic/Center
An outpatient entity, facility, or distinct part of a facility within or affiliated with a Critical Access Hospital that provides access to primary care services for individuals in a small rural community and is Medicare certified.

CLIA Record

Field Name	Field Value
CLIA Number	05D0588097
LAB Type	HOSPITAL
Facility Name	MAMMOTH HOSPITAL LABORATORY
Street	85 SIERRA PARK RD
City	MAMMOTH LAKES
State	CA
ZIP	93546
Phone	(760) 924-4090

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This page was last updated on: 5/11/2023