06D2161861 CLIA NUMBER - ADVANCED PRACTICE HEADACHE & PRIMARY CARE CLINIC

Laboratory Demographics

  • CLIA Code: 06D2161861
  • Facility Name: ADVANCED PRACTICE HEADACHE & PRIMARY CARE CLINIC
  • Facility Address: 1128 EAGLERIDGE BLVD
    PUEBLO, CO
    ZIP 81008
  • Facility Phone: 719 778-1414
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: ZSUZSA GLASSCOCK
  • NPI Number: 1013490259
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 06D2161861
LAB Type Practitioner Other
Facility Name ADVANCED PRACTICE HEADACHE & PRIMARY CARE CLINIC
Street 1128 EAGLERIDGE BLVD
City PUEBLO
State CO
ZIP 81008
Phone 719 778-1414
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/12/2025
Certificate Expiration Date 2/11/2027
Facility Type Practitioner Other
Lab Director ZSUZSA GLASSCOCK

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