32D2104909 CLIA NUMBER - FLT LLC

Laboratory Demographics

CLIA Number: 32D2104909

Facility Name: FLT LLC

Facility Address:
607 W COUNTRY CLUB ROAD
ROSWELL, NM
ZIP 88201
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Facility Phone Number: 575 208-7795

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1366810970

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	32D2104909
LAB Type	Physician Office
Facility Name	FLT LLC
Street	607 W COUNTRY CLUB ROAD
City	ROSWELL
State	NM
ZIP	88201
Phone	575 208-7795
CertificateType	4
CertificateEffectiveDate	11/16/2023
CertificateExpirationDate	11/15/2025
FacilityType	Waiver

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