53D2188511 CLIA NUMBER - BIG HORN PEDIATRICS & FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 53D2188511
  • Facility Name: BIG HORN PEDIATRICS & FAMILY MEDICINE
  • Facility Address: 38 NORTH DESMET AVE SUITE 1
    BUFFALO, WY
    ZIP 82834
  • Facility Phone: 307 620-8845
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID FALL
  • NPI Number: 1366502726
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 53D2188511
LAB Type Physician Office
Facility Name BIG HORN PEDIATRICS & FAMILY MEDICINE
Street 38 NORTH DESMET AVE SUITE 1
City BUFFALO
State WY
ZIP 82834
Phone 307 620-8845
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/12/2024
Certificate Expiration Date 12/11/2026
Facility Type Physician Office
Lab Director DAVID FALL

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