06D0667974 CLIA NUMBER - SOUTHERN UTE HEALTH CENTER

Laboratory Demographics

CLIA Number: 06D0667974

Facility Name: SOUTHERN UTE HEALTH CENTER

Facility Address:
69 CAPOTO DRIVE
IGNACIO, CO
ZIP 81137
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Facility Phone Number: 970 563-4581

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1104950641

Taxonomy: 332800000X - Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603.

CLIA Record

Field Name	Field Value
CLIA Number	06D0667974
LAB Type	Federally Qualified Health Center
Facility Name	SOUTHERN UTE HEALTH CENTER
Street	69 CAPOTO DRIVE
City	IGNACIO
State	CO
ZIP	81137
Phone	970 563-4581
CertificateType	3
CertificateEffectiveDate	4/19/2024
CertificateExpirationDate	4/18/2026
FacilityType	PPMP

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This page was last updated on: 4/23/2024