53D2295008 CLIA NUMBER - HEALTH WEST EVANSTON

Laboratory Demographics

CLIA Number: 53D2295008

Facility Name: HEALTH WEST EVANSTON

Facility Address:
75 YELLOW CREEK RD, SUITE 102
EVANSTON, WY
ZIP 82930
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Facility Phone Number: 307 789-8290

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1619683547

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	53D2295008
LAB Type	Federally Qualified Health Center
Facility Name	HEALTH WEST EVANSTON
Street	75 YELLOW CREEK RD, SUITE 102
City	EVANSTON
State	WY
ZIP	82930
Phone	307 789-8290
CertificateType	3
CertificateEffectiveDate	12/4/2023
CertificateExpirationDate	12/3/2025
FacilityType	PPMP

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