06D1027647 CLIA NUMBER - PUEBLO ENDOSCOPY SUITES, LLC

Laboratory Demographics

CLIA Number: 06D1027647

Facility Name: PUEBLO ENDOSCOPY SUITES, LLC

Facility Address:
1600 N GRAND AVE, STE 420
PUEBLO, CO
ZIP 81003
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Facility Phone Number: 719 543-3500

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1437175627

Taxonomy: 261QE0800X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	06D1027647
LAB Type	Ambulatory Surgery Center
Facility Name	PUEBLO ENDOSCOPY SUITES, LLC
Street	1600 N GRAND AVE, STE 420
City	PUEBLO
State	CO
ZIP	81003
Phone	719 543-3500
CertificateType	4
CertificateEffectiveDate	7/6/2022
CertificateExpirationDate	7/5/2024
FacilityType	Waiver

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