27D2315683 CLIA NUMBER - MOUNTAINSIDE MEDICAL, LLC

Laboratory Demographics

  • CLIA Code: 27D2315683
  • Facility Name: MOUNTAINSIDE MEDICAL, LLC
  • Facility Address: 212 MAIN ST
    STEVENSVILLE, MT
    ZIP 59870
  • Facility Phone: 406 303-9781
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: CARSON C. GOMEZ
  • NPI Number: 1487482543
  • Taxonomy: 363LA2200X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 27D2315683
LAB Type Practitioner Other
Facility Name MOUNTAINSIDE MEDICAL, LLC
Street 212 MAIN ST
City STEVENSVILLE
State MT
ZIP 59870
Phone 406 303-9781
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2024
Certificate Expiration Date 12/16/2026
Facility Type Practitioner Other
Lab Director CARSON C. GOMEZ

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