27D2271119 CLIA NUMBER - PETERSEN CONCIERGE MEDICAL, PLLC

Laboratory Demographics

  • CLIA Code: 27D2271119
  • Facility Name: PETERSEN CONCIERGE MEDICAL, PLLC
  • Facility Address: 2315 MCDONALD AVENUE, SUITE 110
    MISSOULA, MT
    ZIP 59801
  • Facility Phone: 406 541-7040
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CAMILLA E. JUHL PETERSEN
  • NPI Number: 1245957737
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 27D2271119
LAB Type Physician Office
Facility Name PETERSEN CONCIERGE MEDICAL, PLLC
Street 2315 MCDONALD AVENUE, SUITE 110
City MISSOULA
State MT
ZIP 59801
Phone 406 541-7040
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/27/2024
Certificate Expiration Date 10/26/2026
Facility Type Physician Office
Lab Director CAMILLA E. JUHL PETERSEN

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