53D0986799 CLIA NUMBER - SUMMIT MEMORIAL MEDICAL GROUP LLC

Laboratory Demographics

  • CLIA Code: 53D0986799
  • Facility Name: SUMMIT MEMORIAL MEDICAL GROUP LLC
  • Facility Address: 6500 E 2ND STREET
    CASPER, WY
    ZIP 82609
  • Facility Phone: 307 233-0591
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANNA COBB
  • NPI Number: 1598469462
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 53D0986799
LAB Type Physician Office
Facility Name SUMMIT MEMORIAL MEDICAL GROUP LLC
Street 6500 E 2ND STREET
City CASPER
State WY
ZIP 82609
Phone 307 233-0591
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2025
Certificate Expiration Date 4/5/2027
Facility Type Physician Office
Lab Director ANNA COBB

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