53D0520209 CLIA NUMBER - FAMILY PRACTICE ASSOCIATES

Laboratory Demographics

  • CLIA Code: 53D0520209
  • Facility Name: FAMILY PRACTICE ASSOCIATES
  • Facility Address: 557 E BROADWAY PO BOX 2468
    JACKSON, WY
    ZIP 83001
  • Facility Phone: 307 733-7771
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: RICHARD G. SUGDEN MD
  • NPI Number: 1881883858
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 53D0520209
LAB Type Physician Office
Facility Name FAMILY PRACTICE ASSOCIATES
Street 557 E BROADWAY PO BOX 2468
City JACKSON
State WY
ZIP 83001
Phone 307 733-7771
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/1/2025
Certificate Expiration Date 2/28/2027
Facility Type Physician Office
Lab Director RICHARD G. SUGDEN MD

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