53D0666667 CLIA NUMBER - ST JOHNS FAMILY HEALTH & URGENT CARE WEST BROADWAY

Laboratory Demographics

  • CLIA Code: 53D0666667
  • Facility Name: ST JOHNS FAMILY HEALTH & URGENT CARE WEST BROADWAY
  • Facility Address: 455 WEST BROADWAY, SUITE B
    JACKSON, WY
    ZIP 83001
  • Facility Phone: 307 739-6111
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KEVIN C. SANVILLE
  • NPI Number: 1356556518
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 53D0666667
LAB Type Physician Office
Facility Name ST JOHNS FAMILY HEALTH & URGENT CARE WEST BROADWAY
Street 455 WEST BROADWAY, SUITE B
City JACKSON
State WY
ZIP 83001
Phone 307 739-6111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/31/2024
Certificate Expiration Date 5/30/2026
Facility Type Physician Office
Lab Director KEVIN C. SANVILLE

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