53D1092482 CLIA NUMBER - EASTERN SHOSHONE TRIBAL HEALTH

Laboratory Demographics

  • CLIA Code: 53D1092482
  • Facility Name: EASTERN SHOSHONE TRIBAL HEALTH
  • Facility Address: 15230 US HWY 287
    FORT WASHAKIE, WY
    ZIP 82514
  • Facility Phone: 307 332-6805
  • Facility Type: Other - TRIBAL HEALTH PROGRAM
  • Facility Type: Waiver
  • Lab Director: DAVID J. MEYERS
  • NPI Number: 1902240070
  • Taxonomy: 261QP0904X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 53D1092482
LAB Type Other - TRIBAL HEALTH PROGRAM
Facility Name EASTERN SHOSHONE TRIBAL HEALTH
Street 15230 US HWY 287
City FORT WASHAKIE
State WY
ZIP 82514
Phone 307 332-6805
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/25/2024
Certificate Expiration Date 11/24/2026
Facility Type Other - TRIBAL HEALTH PROGRAM
Lab Director DAVID J. MEYERS

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