53D2198018 CLIA NUMBER - BANNER HEALTH PHYSICIANS WEST LLC

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Laboratory Demographics

CLIA Number: 53D2198018

Facility Name: BANNER HEALTH PHYSICIANS WEST LLC

Facility Address:
400 S 15TH ST, STE 101
WORLAND, WY
ZIP 82401
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Facility Phone Number: 307 347-6937

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1558601278

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	53D2198018
LAB Type	Physician Office
Facility Name	BANNER HEALTH PHYSICIANS WEST LLC
Street	400 S 15TH ST, STE 101
City	WORLAND
State	WY
ZIP	82401
Phone	307 347-6937
CertificateType	4
CertificateEffectiveDate	10/29/2022
CertificateExpirationDate	10/28/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024