06D2197453 CLIA NUMBER - BOULDER PLASTIC SURGERY, PLLC

Laboratory Demographics

  • CLIA Code: 06D2197453
  • Facility Name: BOULDER PLASTIC SURGERY, PLLC
  • Facility Address: 2525 4TH STREET, SUITE 200
    BOULDER, CO
    ZIP 80304
  • Facility Phone: 303 443-2277
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JUSTIN B. MAXHIMER
  • NPI Number: 1043251432
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 06D2197453
LAB Type Physician Office
Facility Name BOULDER PLASTIC SURGERY, PLLC
Street 2525 4TH STREET, SUITE 200
City BOULDER
State CO
ZIP 80304
Phone 303 443-2277
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2024
Certificate Expiration Date 10/25/2026
Facility Type Physician Office
Lab Director DR. JUSTIN B. MAXHIMER

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