06D2196076 CLIA NUMBER - MASTERMIND CLINIC, PLLC

Laboratory Demographics

  • CLIA Code: 06D2196076
  • Facility Name: MASTERMIND CLINIC, PLLC
  • Facility Address: 320 E FONTANERO STREET, #301
    COLORADO SPRINGS, CO
    ZIP 80907
  • Facility Phone: 719 644-6463
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JENNIE STORMES
  • NPI Number: 1285247486
  • Taxonomy: 363LP0808X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 06D2196076
LAB Type Practitioner Other
Facility Name MASTERMIND CLINIC, PLLC
Street 320 E FONTANERO STREET, #301
City COLORADO SPRINGS
State CO
ZIP 80907
Phone 719 644-6463
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/14/2024
Certificate Expiration Date 10/13/2026
Facility Type Practitioner Other
Lab Director JENNIE STORMES

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