06D0691762 CLIA NUMBER - GREEN MOUNTAIN CLINIC PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 06D0691762
  • Facility Name: GREEN MOUNTAIN CLINIC PRIMARY CARE
  • Facility Address: 12790 W ALAMEDA PKWY, SUITE A
    LAKEWOOD, CO
    ZIP 80228
  • Facility Phone: 303 403-6350
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. EDWARD SHUHERK
  • NPI Number: 1992313373
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 06D0691762
LAB Type Physician Office
Facility Name GREEN MOUNTAIN CLINIC PRIMARY CARE
Street 12790 W ALAMEDA PKWY, SUITE A
City LAKEWOOD
State CO
ZIP 80228
Phone 303 403-6350
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/5/2025
Certificate Expiration Date 2/4/2027
Facility Type Physician Office
Lab Director DR. EDWARD SHUHERK

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