06D2173237 CLIA NUMBER - SOCO PRIMARY CARE CLINIC

Laboratory Demographics

  • CLIA Code: 06D2173237
  • Facility Name: SOCO PRIMARY CARE CLINIC
  • Facility Address: 1310 FORTINO BLVD, SUITE D
    PUEBLO, CO
    ZIP 81008
  • Facility Phone: 719 582-1898
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: NICOLE L. BETTS
  • NPI Number: 1124677729
  • Taxonomy: 363LA2200X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 06D2173237
LAB Type Practitioner Other
Facility Name SOCO PRIMARY CARE CLINIC
Street 1310 FORTINO BLVD, SUITE D
City PUEBLO
State CO
ZIP 81008
Phone 719 582-1898
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/8/2025
Certificate Expiration Date 10/7/2027
Facility Type Practitioner Other
Lab Director NICOLE L. BETTS

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