06D2100092 CLIA NUMBER - ASPEN GROVE FAMILY PRACTICE, LLC

Laboratory Demographics

CLIA Number: 06D2100092

Facility Name: ASPEN GROVE FAMILY PRACTICE, LLC

Facility Address:
3096 I-70 BUSINESS LOOP UNIT D
GRAND JUNCTION, CO
ZIP 81504
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Facility Phone Number: 970 314-2805

Facility Type: Practitioner Other

Certificate Type: Microscopy

NPI Number: 1073903464

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	06D2100092
LAB Type	Practitioner Other
Facility Name	ASPEN GROVE FAMILY PRACTICE, LLC
Street	3096 I-70 BUSINESS LOOP UNIT D
City	GRAND JUNCTION
State	CO
ZIP	81504
Phone	970 314-2805
CertificateType	3
CertificateEffectiveDate	8/7/2023
CertificateExpirationDate	8/6/2025
FacilityType	PPMP

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