06D1080809 CLIA NUMBER - MIDVALLEY FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 06D1080809
  • Facility Name: MIDVALLEY FAMILY PRACTICE
  • Facility Address: 1450 E VALLEY ROAD #102
    BASALT, CO
    ZIP 81621
  • Facility Phone: 970 927-4666
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: GLENN E. KOTZ
  • NPI Number: 1568559748
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 06D1080809
LAB Type Physician Office
Facility Name MIDVALLEY FAMILY PRACTICE
Street 1450 E VALLEY ROAD #102
City BASALT
State CO
ZIP 81621
Phone 970 927-4666
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 10/1/2025
Certificate Expiration Date 9/30/2027
Facility Type Physician Office
Lab Director GLENN E. KOTZ

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