32D2151900 CLIA NUMBER - MEMORIAL INTERNAL MEDICINE

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Laboratory Demographics

CLIA Number: 32D2151900

Facility Name: MEMORIAL INTERNAL MEDICINE

Facility Address:
3030 W PICACHO STREET SUITE D
LAS CRUCES, NM
ZIP 88007
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Facility Phone Number: 575 556-6470

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1760740245

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	32D2151900
LAB Type	Physician Office
Facility Name	MEMORIAL INTERNAL MEDICINE
Street	3030 W PICACHO STREET SUITE D
City	LAS CRUCES
State	NM
ZIP	88007
Phone	575 556-6470
CertificateType	4
CertificateEffectiveDate	7/31/2022
CertificateExpirationDate	7/30/2024
FacilityType	Waiver

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