06D2104958 CLIA NUMBER - TABEGUACHE FAMILY AND SPORTS MEDICINE

Laboratory Demographics

  • CLIA Code: 06D2104958
  • Facility Name: TABEGUACHE FAMILY AND SPORTS MEDICINE
  • Facility Address: 3150 NORTH 12TH STREET
    GRAND JUNCTION, CO
    ZIP 81506
  • Facility Phone: 970 256-5201
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. DAN P. SULLIVAN
  • NPI Number: 1417455403
  • Taxonomy: 207QS0010X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 06D2104958
LAB Type Physician Office
Facility Name TABEGUACHE FAMILY AND SPORTS MEDICINE
Street 3150 NORTH 12TH STREET
City GRAND JUNCTION
State CO
ZIP 81506
Phone 970 256-5201
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 11/16/2023
Certificate Expiration Date 11/15/2025
Facility Type Physician Office
Lab Director DR. DAN P. SULLIVAN

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