06D2255924 CLIA NUMBER - UCHEALTH IMAGING - LONGS PEAK MEDICAL CENTER

Laboratory Demographics

CLIA Number: 06D2255924

Facility Name: UCHEALTH IMAGING - LONGS PEAK MEDICAL CENTER

Facility Address:
1760 E KEN PRATT BLVD, STE 101
LONGMONT, CO
ZIP 80504
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Facility Phone Number: 720 718-5100

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1578218723

Taxonomy: 261QR0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	06D2255924
LAB Type	Physician Office
Facility Name	UCHEALTH IMAGING - LONGS PEAK MEDICAL CENTER
Street	1760 E KEN PRATT BLVD, STE 101
City	LONGMONT
State	CO
ZIP	80504
Phone	720 718-5100
CertificateType	4
CertificateEffectiveDate	3/18/2024
CertificateExpirationDate	3/17/2026
FacilityType	Waiver

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