06D1084057 CLIA NUMBER - SOUTHERN COLORADO CLINIC, PC

Laboratory Demographics

CLIA Number: 06D1084057

Facility Name: SOUTHERN COLORADO CLINIC, PC

Facility Address:
3937 IVYWOOD LN
PUEBLO, CO
ZIP 81005
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Facility Phone Number: 719 553-1808

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1598371056

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	06D1084057
LAB Type	Physician Office
Facility Name	SOUTHERN COLORADO CLINIC, PC
Street	3937 IVYWOOD LN
City	PUEBLO
State	CO
ZIP	81005
Phone	719 553-1808
CertificateType	3
CertificateEffectiveDate	5/15/2024
CertificateExpirationDate	5/14/2026
FacilityType	PPMP

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