06D2240407 CLIA NUMBER - COUNTY LINE HEALTH CLINIC

Laboratory Demographics

CLIA Number: 06D2240407

Facility Name: COUNTY LINE HEALTH CLINIC

Facility Address:
36053 US HIGHWAY 287
WILEY, CO
ZIP 81092
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Facility Phone Number: 719 829-4030

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1124795836

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	06D2240407
LAB Type	Practitioner Other
Facility Name	COUNTY LINE HEALTH CLINIC
Street	36053 US HIGHWAY 287
City	WILEY
State	CO
ZIP	81092
Phone	719 829-4030
CertificateType	4
CertificateEffectiveDate	10/19/2023
CertificateExpirationDate	10/18/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024