06D0515719 CLIA NUMBER - FRONTIER INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 06D0515719
  • Facility Name: FRONTIER INTERNAL MEDICINE
  • Facility Address: 2101 KEN PRATT BLVD, STE 104
    LONGMONT, CO
    ZIP 80501
  • Facility Phone: 303 415-4156
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JASON SMOUSE
  • NPI Number: 1376624619
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 06D0515719
LAB Type Physician Office
Facility Name FRONTIER INTERNAL MEDICINE
Street 2101 KEN PRATT BLVD, STE 104
City LONGMONT
State CO
ZIP 80501
Phone 303 415-4156
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/11/2025
Certificate Expiration Date 4/10/2027
Facility Type Physician Office
Lab Director DR. JASON SMOUSE

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