06D0940033 CLIA NUMBER - GRAND JUNCTION PEDIATRIC SPECIALTY CLINIC

Laboratory Demographics

CLIA Number: 06D0940033

Facility Name: GRAND JUNCTION PEDIATRIC SPECIALTY CLINIC

Facility Address:
2643 PATTERSON RD, STE 405
GRAND JUNCTION, CO
ZIP 81506
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Facility Phone Number: 970 298-7440

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1992912430

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	06D0940033
LAB Type	Physician Office
Facility Name	GRAND JUNCTION PEDIATRIC SPECIALTY CLINIC
Street	2643 PATTERSON RD, STE 405
City	GRAND JUNCTION
State	CO
ZIP	81506
Phone	970 298-7440
CertificateType	4
CertificateEffectiveDate	2/4/2024
CertificateExpirationDate	2/3/2026
FacilityType	Waiver

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