27D1004564 CLIA NUMBER - MONTANA MEDICAL RESEARCH

Laboratory Demographics

CLIA Number: 27D1004564

Facility Name: MONTANA MEDICAL RESEARCH

Facility Address:
2673 PALMER STREET, SUITE 102
MISSOULA, MT
ZIP 59808
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Facility Phone Number: 406 549-1124

Facility Type: Independent

Certificate Type: Waiver

NPI Number: 1922699644

Taxonomy: 1744R1102X - Specialist

CLIA Record

Field Name	Field Value
CLIA Number	27D1004564
LAB Type	Independent
Facility Name	MONTANA MEDICAL RESEARCH
Street	2673 PALMER STREET, SUITE 102
City	MISSOULA
State	MT
ZIP	59808
Phone	406 549-1124
CertificateType	4
CertificateEffectiveDate	10/1/2022
CertificateExpirationDate	9/30/2024
FacilityType	Waiver

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