06D2319272 CLIA NUMBER - RIVENDELL HEALTH PC

Laboratory Demographics

  • CLIA Code: 06D2319272
  • Facility Name: RIVENDELL HEALTH PC
  • Facility Address: 1465 KELLY JOHNSON BLVD, #310
    COLORADO SPRINGS, CO
    ZIP 80920
  • Facility Phone: 719 726-6573
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL R. FRY
  • NPI Number: 1730927567
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 06D2319272
LAB Type Physician Office
Facility Name RIVENDELL HEALTH PC
Street 1465 KELLY JOHNSON BLVD, #310
City COLORADO SPRINGS
State CO
ZIP 80920
Phone 719 726-6573
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/26/2025
Certificate Expiration Date 2/25/2027
Facility Type Physician Office
Lab Director MICHAEL R. FRY

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