06D0518999 CLIA NUMBER - PEDIATRIC ASSOCIATES PROF LLC

Laboratory Demographics

  • CLIA Code: 06D0518999
  • Facility Name: PEDIATRIC ASSOCIATES PROF LLC
  • Facility Address: 947 SOUTH 5TH ST
    MONTROSE, CO
    ZIP 81401
  • Facility Phone: 970 249-2421
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: DR. ROMEO ICASIANO
  • NPI Number: 1548261324
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 06D0518999
LAB Type Rural Health Clinic
Facility Name PEDIATRIC ASSOCIATES PROF LLC
Street 947 SOUTH 5TH ST
City MONTROSE
State CO
ZIP 81401
Phone 970 249-2421
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/11/2025
Certificate Expiration Date 1/10/2027
Facility Type Rural Health Clinic
Lab Director DR. ROMEO ICASIANO

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