53D2210975 CLIA NUMBER - CODY CLINIC

Laboratory Demographics

  • CLIA Code: 53D2210975
  • Facility Name: CODY CLINIC
  • Facility Address: 2107 SHERIDAN AVE
    CODY, WY
    ZIP 82414
  • Facility Phone: 307 586-5303
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JUDD LAROWE
  • NPI Number: 1104422237
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 53D2210975
LAB Type Physician Office
Facility Name CODY CLINIC
Street 2107 SHERIDAN AVE
City CODY
State WY
ZIP 82414
Phone 307 586-5303
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2025
Certificate Expiration Date 1/24/2027
Facility Type Physician Office
Lab Director JUDD LAROWE

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