53D0663216 CLIA NUMBER - CHEYENNE FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 53D0663216
  • Facility Name: CHEYENNE FAMILY MEDICINE
  • Facility Address: 1950 BLUEGRASS CIRCLE, SUITE 200
    CHEYENNE, WY
    ZIP 82009
  • Facility Phone: 307 778-2577
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JONATHON MEDINA
  • NPI Number: 1497412670
  • Taxonomy: 207Q00000X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 53D0663216
LAB Type Physician Office
Facility Name CHEYENNE FAMILY MEDICINE
Street 1950 BLUEGRASS CIRCLE, SUITE 200
City CHEYENNE
State WY
ZIP 82009
Phone 307 778-2577
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/8/2023
Certificate Expiration Date 12/7/2025
Facility Type Physician Office
Lab Director JONATHON MEDINA

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