29D0926246 CLIA NUMBER - TONOPAH PRIMARY CARE LLC

Laboratory Demographics

CLIA Number: 29D0926246

Facility Name: TONOPAH PRIMARY CARE LLC

Facility Address:
119 ST PATRICK ST
TONOPAH, NV
ZIP 89049
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Facility Phone Number: 775 482-9898

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1003305616

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	29D0926246
LAB Type	Practitioner Other
Facility Name	TONOPAH PRIMARY CARE LLC
Street	119 ST PATRICK ST
City	TONOPAH
State	NV
ZIP	89049
Phone	775 482-9898
CertificateType	4
CertificateEffectiveDate	3/18/2023
CertificateExpirationDate	3/17/2025
FacilityType	Waiver

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