06D1056575 CLIA NUMBER - GRAND VALLEY PRIMARY CARE FRUITA

Laboratory Demographics

  • CLIA Code: 06D1056575
  • Facility Name: GRAND VALLEY PRIMARY CARE FRUITA
  • Facility Address: 101 JURASSIC AVE, SUITE C
    FRUITA, CO
    ZIP 81521
  • Facility Phone: 970 644-3830
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. REBECCA FULMER
  • NPI Number: 1487291225
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 06D1056575
LAB Type Physician Office
Facility Name GRAND VALLEY PRIMARY CARE FRUITA
Street 101 JURASSIC AVE, SUITE C
City FRUITA
State CO
ZIP 81521
Phone 970 644-3830
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 7/19/2024
Certificate Expiration Date 7/18/2026
Facility Type Physician Office
Lab Director DR. REBECCA FULMER

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