06D0674140 CLIA NUMBER - HERITAGE INTERNAL MEDICINE PC

Laboratory Demographics

  • CLIA Code: 06D0674140
  • Facility Name: HERITAGE INTERNAL MEDICINE PC
  • Facility Address: 1925 E ORMAN 535A
    PUEBLO, CO
    ZIP 81004
  • Facility Phone: 719 564-0450
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: THOMAS K. GAIDE
  • NPI Number: 1669681581
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 06D0674140
LAB Type Physician Office
Facility Name HERITAGE INTERNAL MEDICINE PC
Street 1925 E ORMAN 535A
City PUEBLO
State CO
ZIP 81004
Phone 719 564-0450
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/10/2024
Certificate Expiration Date 5/9/2026
Facility Type Physician Office
Lab Director THOMAS K. GAIDE

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