32D2276898 CLIA NUMBER - ACTIVE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 32D2276898
  • Facility Name: ACTIVE MEDICAL GROUP
  • Facility Address: 4760 N BUTLER AVE SUITE D
    FARMINGTON, NM
    ZIP 87401
  • Facility Phone: 505 370-1201
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ASHLEY J. SMITH
  • NPI Number: 1992408520
  • Taxonomy: 363LF0000X - Nurse Practitioner

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 32D2276898
LAB Type Physician Office
Facility Name ACTIVE MEDICAL GROUP
Street 4760 N BUTLER AVE SUITE D
City FARMINGTON
State NM
ZIP 87401
Phone 505 370-1201
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/16/2025
Certificate Expiration Date 2/15/2027
Facility Type Physician Office
Lab Director ASHLEY J. SMITH

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 9/29/2025