06D2081991 CLIA NUMBER - METAMORPHOSIS, LTD

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Laboratory Demographics

CLIA Number: 06D2081991

Facility Name: METAMORPHOSIS, LTD

Facility Address:
113 LATIGO LANE, SUITE D
CANON CITY, CO
ZIP 81212
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Facility Phone Number: 719 371-0000

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1760929590

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	06D2081991
LAB Type	Physician Office
Facility Name	METAMORPHOSIS, LTD
Street	113 LATIGO LANE, SUITE D
City	CANON CITY
State	CO
ZIP	81212
Phone	719 371-0000
CertificateType	4
CertificateEffectiveDate	8/5/2022
CertificateExpirationDate	8/4/2024
FacilityType	Waiver

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