06D2291005 CLIA NUMBER - PRAIRIE CLINIC LLC

Laboratory Demographics

  • CLIA Code: 06D2291005
  • Facility Name: PRAIRIE CLINIC LLC
  • Facility Address: 172 WEST 1ST STREET
    SPRINGFIELD, CO
    ZIP 81073
  • Facility Phone: 719 691-4488
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: ANN R. TENNILLE
  • NPI Number: 1740992676
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 06D2291005
LAB Type Practitioner Other
Facility Name PRAIRIE CLINIC LLC
Street 172 WEST 1ST STREET
City SPRINGFIELD
State CO
ZIP 81073
Phone 719 691-4488
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/4/2023
Certificate Expiration Date 10/3/2025
Facility Type Practitioner Other
Lab Director ANN R. TENNILLE

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