06D0515984 CLIA NUMBER - MIRAMONT FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 06D0515984
  • Facility Name: MIRAMONT FAMILY MEDICINE
  • Facility Address: 4674 SNOW MESA DR, STE 140
    FORT COLLINS, CO
    ZIP 80528
  • Facility Phone: 970 482-0213
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: DR. INGERLISA MATTOCH
  • NPI Number: 1770919409
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 06D0515984
LAB Type Physician Office
Facility Name MIRAMONT FAMILY MEDICINE
Street 4674 SNOW MESA DR, STE 140
City FORT COLLINS
State CO
ZIP 80528
Phone 970 482-0213
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 11/20/2023
Certificate Expiration Date 11/19/2025
Facility Type Physician Office
Lab Director DR. INGERLISA MATTOCH

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