32D0987869 CLIA NUMBER - GALLUP VA COMMUNITY BASED CLINIC

Laboratory Demographics

CLIA Number: 32D0987869

Facility Name: GALLUP VA COMMUNITY BASED CLINIC

Facility Address:
1985 STATE ROAD 602
GALLUP, NM
ZIP 87301
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Facility Phone Number: 505 863-4431

Facility Type: Community Clinic

Certificate Type: Accreditation

NPI Number: 1477509172

Taxonomy: 261QV0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	32D0987869
LAB Type	Community Clinic
Facility Name	GALLUP VA COMMUNITY BASED CLINIC
Street	1985 STATE ROAD 602
City	GALLUP
State	NM
ZIP	87301
Phone	505 863-4431
CertificateType	1
CertificateEffectiveDate	6/15/2001
CertificateExpirationDate	5/22/2026
FacilityType	Accreditation

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