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53D0903460 CLIA NUMBER - GOOSE CREEK PEDIATRICS

Laboratory Demographics

CLIA Number: 53D0903460

Facility Name: GOOSE CREEK PEDIATRICS

Facility Address:
1701 WEST FIFTH STREET SUITE A
SHERIDAN, WY
ZIP 82801
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Facility Phone Number: 307 672-7700

Facility Type: Physician Office

Certificate Type: Microscopy
NPI Number: 1215414875

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name Field Value
CLIA Number 53D0903460
LAB Type Physician Office
Facility Name GOOSE CREEK PEDIATRICS
Street 1701 WEST FIFTH STREET SUITE A
City SHERIDAN
State WY
ZIP 82801
Phone 307 672-7700
CertificateType 3
CertificateEffectiveDate 7/21/2023
CertificateExpirationDate 7/20/2025
FacilityType PPMP

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This page was last updated on: 4/23/2024