29D0702536 CLIA NUMBER - AMARGOSA VALLEY MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 29D0702536

Facility Name: AMARGOSA VALLEY MEDICAL CLINIC

Facility Address:
1690 E AMAROGSA FARM RD
AMARGOSA VALLEY, NV
ZIP 89020
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Facility Phone Number: 775 372-5432

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1831278720

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	29D0702536
LAB Type	Federally Qualified Health Center
Facility Name	AMARGOSA VALLEY MEDICAL CLINIC
Street	1690 E AMAROGSA FARM RD
City	AMARGOSA VALLEY
State	NV
ZIP	89020
Phone	775 372-5432
CertificateType	4
CertificateEffectiveDate	6/11/2023
CertificateExpirationDate	6/10/2025
FacilityType	Waiver

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