06D2194271 CLIA NUMBER - SOUTHERN COLORADO CLINIC, PC

Laboratory Demographics

  • CLIA Code: 06D2194271
  • Facility Name: SOUTHERN COLORADO CLINIC, PC
  • Facility Address: 109 S BURLINGTON DRIVE
    PUEBLO WEST, CO
    ZIP 81007
  • Facility Phone: 719 553-2200
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. SCOTT A. DERUITER
  • NPI Number: 1285613554
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 06D2194271
LAB Type Physician Office
Facility Name SOUTHERN COLORADO CLINIC, PC
Street 109 S BURLINGTON DRIVE
City PUEBLO WEST
State CO
ZIP 81007
Phone 719 553-2200
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 11/11/2024
Certificate Expiration Date 11/10/2026
Facility Type Physician Office
Lab Director DR. SCOTT A. DERUITER

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