53D2160954 CLIA NUMBER - CHEYENNE HEALTH PLAZA INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 53D2160954
  • Facility Name: CHEYENNE HEALTH PLAZA INTERNAL MEDICINE
  • Facility Address: 800 EAST 20TH STREET, SUITE 350
    CHEYENNE, WY
    ZIP 82001
  • Facility Phone: 307 996-1560
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHANNON COOK
  • NPI Number: 1730847740
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 53D2160954
LAB Type Physician Office
Facility Name CHEYENNE HEALTH PLAZA INTERNAL MEDICINE
Street 800 EAST 20TH STREET, SUITE 350
City CHEYENNE
State WY
ZIP 82001
Phone 307 996-1560
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/23/2025
Certificate Expiration Date 1/22/2027
Facility Type Physician Office
Lab Director SHANNON COOK

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This page was last updated on: 6/4/2025