53D2129489 CLIA NUMBER - STAR VALLEY MEDICAL CENTER - THAYNE CLINIC

Laboratory Demographics

  • CLIA Code: 53D2129489
  • Facility Name: STAR VALLEY MEDICAL CENTER - THAYNE CLINIC
  • Facility Address: 122 PETERSEN PARKWAY
    THAYNE, WY
    ZIP 83127
  • Facility Phone: 307 885-5827
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: MARTHA HAGEMAN
  • NPI Number: 1821610957
  • Taxonomy: 1223S0112X - Dentist

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 53D2129489
LAB Type Community Clinic
Facility Name STAR VALLEY MEDICAL CENTER - THAYNE CLINIC
Street 122 PETERSEN PARKWAY
City THAYNE
State WY
ZIP 83127
Phone 307 885-5827
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 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Community Clinic
Lab Director MARTHA HAGEMAN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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