06D1060170 CLIA NUMBER - PRAIRIE VIEW RURAL HEALTH CLINIC

Laboratory Demographics

CLIA Number: 06D1060170

Facility Name: PRAIRIE VIEW RURAL HEALTH CLINIC

Facility Address:
615 W 5TH ST NORTH
CHEYENNE WELLS, CO
ZIP 80810
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Facility Phone Number: 719 767-9815

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1003067349

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	06D1060170
LAB Type	Rural Health Clinic
Facility Name	PRAIRIE VIEW RURAL HEALTH CLINIC
Street	615 W 5TH ST NORTH
City	CHEYENNE WELLS
State	CO
ZIP	80810
Phone	719 767-9815
CertificateType	4
CertificateEffectiveDate	9/29/2022
CertificateExpirationDate	9/28/2024
FacilityType	Waiver

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