53D1038400 CLIA NUMBER - SWEETWATER PEDIATRICS PC

Laboratory Demographics

  • CLIA Code: 53D1038400
  • Facility Name: SWEETWATER PEDIATRICS PC
  • Facility Address: 1101 GATEWAY BLVD
    ROCK SPRINGS, WY
    ZIP 82901
  • Facility Phone: 307 362-5500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHANDRA YESHLUR
  • NPI Number: 1215135025
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 53D1038400
LAB Type Physician Office
Facility Name SWEETWATER PEDIATRICS PC
Street 1101 GATEWAY BLVD
City ROCK SPRINGS
State WY
ZIP 82901
Phone 307 362-5500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/17/2025
Certificate Expiration Date 3/16/2027
Facility Type Physician Office
Lab Director CHANDRA YESHLUR

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This page was last updated on: 3/20/2025