06D0515466 CLIA NUMBER - EVERGREEN PEDIATRICS

Laboratory Demographics

  • CLIA Code: 06D0515466
  • Facility Name: EVERGREEN PEDIATRICS
  • Facility Address: 30960 STAGECOACH BLVD STE 120
    EVERGREEN, CO
    ZIP 80439
  • Facility Phone: 303 674-6671
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KENNETH J. KUTALEK
  • NPI Number: 1689839144
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 06D0515466
LAB Type Physician Office
Facility Name EVERGREEN PEDIATRICS
Street 30960 STAGECOACH BLVD STE 120
City EVERGREEN
State CO
ZIP 80439
Phone 303 674-6671
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/9/2025
Certificate Expiration Date 6/8/2027
Facility Type Physician Office
Lab Director KENNETH J. KUTALEK

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