06D1090669 CLIA NUMBER - PENRAD IMAGING

Laboratory Demographics

CLIA Number: 06D1090669

Facility Name: PENRAD IMAGING

Facility Address:
3050 N CIRCLE DRIVE
COLORADO SPRINGS, CO
ZIP 80909
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Facility Phone Number: 719 785-9000

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1003906868

Taxonomy: 261QR0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	06D1090669
LAB Type	Other
Facility Name	PENRAD IMAGING
Street	3050 N CIRCLE DRIVE
City	COLORADO SPRINGS
State	CO
ZIP	80909
Phone	719 785-9000
CertificateType	4
CertificateEffectiveDate	10/16/2022
CertificateExpirationDate	10/15/2024
FacilityType	Waiver

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