06D0675068 CLIA NUMBER - ROARING FORK FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 06D0675068
  • Facility Name: ROARING FORK FAMILY PRACTICE
  • Facility Address: 978 EUCLID AVENUE
    CARBONDALE, CO
    ZIP 81623
  • Facility Phone: 970 963-3350
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. ANDREW W. GISLESON
  • NPI Number: 1063630226
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 06D0675068
LAB Type Physician Office
Facility Name ROARING FORK FAMILY PRACTICE
Street 978 EUCLID AVENUE
City CARBONDALE
State CO
ZIP 81623
Phone 970 963-3350
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director DR. ANDREW W. GISLESON

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