32D2232892 CLIA NUMBER - PROACTIVE MD HOLLY FRONTIER LIVING WELL HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 32D2232892
  • Facility Name: PROACTIVE MD HOLLY FRONTIER LIVING WELL HEALTH CENTER
  • Facility Address: 1107 E MAIN ST
    ARTESIA, NM
    ZIP 88210
  • Facility Phone: 575 616-5999
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MARTA GALLEGOS
  • NPI Number: 1205416732
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 32D2232892
LAB Type Practitioner Other
Facility Name PROACTIVE MD HOLLY FRONTIER LIVING WELL HEALTH CENTER
Street 1107 E MAIN ST
City ARTESIA
State NM
ZIP 88210
Phone 575 616-5999
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/18/2023
Certificate Expiration Date 8/17/2025
Facility Type Practitioner Other
Lab Director MARTA GALLEGOS

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This page was last updated on: 3/20/2025