06D0928580 CLIA NUMBER - AGEWELL MEDICAL ASSOCIATES PC

Laboratory Demographics

CLIA Number: 06D0928580

Facility Name: AGEWELL MEDICAL ASSOCIATES PC

Facility Address:
2350 INTERNATIONAL CIR
COLORADO SPRINGS, CO
ZIP 80910
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Facility Phone Number: 719 475-5065

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1144341959

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	06D0928580
LAB Type	Physician Office
Facility Name	AGEWELL MEDICAL ASSOCIATES PC
Street	2350 INTERNATIONAL CIR
City	COLORADO SPRINGS
State	CO
ZIP	80910
Phone	719 475-5065
CertificateType	4
CertificateEffectiveDate	5/21/2023
CertificateExpirationDate	5/20/2025
FacilityType	Waiver

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