06D2004670 CLIA NUMBER - INTERMOUNTAIN ANESTHESIA PROFESSIONAL CONSULTANTS

Laboratory Demographics

  • CLIA Code: 06D2004670
  • Facility Name: INTERMOUNTAIN ANESTHESIA PROFESSIONAL CONSULTANTS
  • Facility Address: 1175 58TH AVE, STE 200
    GREELEY, CO
    ZIP 80634
  • Facility Phone: 970 495-0444
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JAN G. GILLESPIE WAGNER
  • NPI Number: 1497334478
  • Taxonomy: 207VG0400X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 06D2004670
LAB Type Physician Office
Facility Name INTERMOUNTAIN ANESTHESIA PROFESSIONAL CONSULTANTS
Street 1175 58TH AVE, STE 200
City GREELEY
State CO
ZIP 80634
Phone 970 495-0444
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/10/2024
Certificate Expiration Date 3/9/2026
Facility Type Physician Office
Lab Director DR. JAN G. GILLESPIE WAGNER

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