53D0663229 CLIA NUMBER - BIG HORN PEDIATRICS PC

Laboratory Demographics

  • CLIA Code: 53D0663229
  • Facility Name: BIG HORN PEDIATRICS PC
  • Facility Address: 1308 WEST 4TH STREET
    GILLETTE, WY
    ZIP 82716
  • Facility Phone: 307 687-1300
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID R. FALL
  • NPI Number: 1477660447
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 53D0663229
LAB Type Physician Office
Facility Name BIG HORN PEDIATRICS PC
Street 1308 WEST 4TH STREET
City GILLETTE
State WY
ZIP 82716
Phone 307 687-1300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/17/2024
Certificate Expiration Date 2/16/2026
Facility Type Physician Office
Lab Director DAVID R. FALL

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