32D2293498 CLIA NUMBER - ZIA PRIMARY CARE, LLC

Laboratory Demographics

  • CLIA Code: 32D2293498
  • Facility Name: ZIA PRIMARY CARE, LLC
  • Facility Address: 104 QUAIL TRAIL STE B
    EDGEWOOD, NM
    ZIP 87015
  • Facility Phone: 505 926-9800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JODI DETTMAN
  • NPI Number: 1831802230
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 32D2293498
LAB Type Physician Office
Facility Name ZIA PRIMARY CARE, LLC
Street 104 QUAIL TRAIL STE B
City EDGEWOOD
State NM
ZIP 87015
Phone 505 926-9800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/9/2023
Certificate Expiration Date 11/8/2025
Facility Type Physician Office
Lab Director JODI DETTMAN

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