06D1014688 CLIA NUMBER - MISSION MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 06D1014688
  • Facility Name: MISSION MEDICAL CLINIC
  • Facility Address: 2125 E LA SALLE STREET
    COLORADO SPRINGS, CO
    ZIP 80909
  • Facility Phone: 719 219-3402
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: ELLERY R. FORTAREL
  • NPI Number: 1730126558
  • Taxonomy: 261QC1500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 06D1014688
LAB Type Community Clinic
Facility Name MISSION MEDICAL CLINIC
Street 2125 E LA SALLE STREET
City COLORADO SPRINGS
State CO
ZIP 80909
Phone 719 219-3402
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2024
Certificate Expiration Date 3/3/2026
Facility Type Community Clinic
Lab Director ELLERY R. FORTAREL

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