53D0520169 CLIA NUMBER - EVANSTON INTERNAL MEDICINE ASSO INC

Laboratory Demographics

  • CLIA Code: 53D0520169
  • Facility Name: EVANSTON INTERNAL MEDICINE ASSO INC
  • Facility Address: 150 ARROWHEAD DR ST#1
    EVANSTON, WY
    ZIP 82930
  • Facility Phone: 307 789-0524
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THOMAS J. SIMON
  • NPI Number: 1619165719
  • Taxonomy: 207R00000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 53D0520169
LAB Type Physician Office
Facility Name EVANSTON INTERNAL MEDICINE ASSO INC
Street 150 ARROWHEAD DR ST#1
City EVANSTON
State WY
ZIP 82930
Phone 307 789-0524
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/5/2023
Certificate Expiration Date 11/4/2025
Facility Type Physician Office
Lab Director THOMAS J. SIMON

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