06D2087210 CLIA NUMBER - WHOLE FAMILY HEALTH CARE OF LONGMONT, PLLC

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Laboratory Demographics

CLIA Number: 06D2087210

Facility Name: WHOLE FAMILY HEALTH CARE OF LONGMONT, PLLC

Facility Address:
600 S AIRPORT RD, BLDG A, SUITE 203
LONGMONT, CO
ZIP 80503
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Facility Phone Number: 303 776-0467

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1932501202

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	06D2087210
LAB Type	Physician Office
Facility Name	WHOLE FAMILY HEALTH CARE OF LONGMONT, PLLC
Street	600 S AIRPORT RD, BLDG A, SUITE 203
City	LONGMONT
State	CO
ZIP	80503
Phone	303 776-0467
CertificateType	4
CertificateEffectiveDate	11/19/2022
CertificateExpirationDate	11/18/2024
FacilityType	Waiver

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