53D0677203 CLIA NUMBER - EVANSTON COMMUNITY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 53D0677203
  • Facility Name: EVANSTON COMMUNITY HEALTH CENTER
  • Facility Address: 75 YELLOW CREEK ROAD, STE 102
    EVANSTON, WY
    ZIP 82930
  • Facility Phone: 307 789-8290
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: JENNA PITMAN
  • NPI Number: 1013916519
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 53D0677203
LAB Type Federally Qualified Health Center
Facility Name EVANSTON COMMUNITY HEALTH CENTER
Street 75 YELLOW CREEK ROAD, STE 102
City EVANSTON
State WY
ZIP 82930
Phone 307 789-8290
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 2/3/2024
Certificate Expiration Date 2/2/2026
Facility Type Federally Qualified Health Center
Lab Director JENNA PITMAN

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