27D2295352 CLIA NUMBER - ROCKY MOUNTAIN EAR, NOSE AND THROAT

Laboratory Demographics

CLIA Number: 27D2295352

Facility Name: ROCKY MOUNTAIN EAR, NOSE AND THROAT

Facility Address:
2760 ELIZABETH WARREN AVE
BUTTE, MT
ZIP 59701
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Facility Phone Number: 406 214-9694

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1811091937

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	27D2295352
LAB Type	Physician Office
Facility Name	ROCKY MOUNTAIN EAR, NOSE AND THROAT
Street	2760 ELIZABETH WARREN AVE
City	BUTTE
State	MT
ZIP	59701
Phone	406 214-9694
CertificateType	4
CertificateEffectiveDate	12/11/2023
CertificateExpirationDate	12/10/2025
FacilityType	Waiver

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