53D2311528 CLIA NUMBER - TETON DERMATOLOGY, LLC DBA EPIPHANY DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 53D2311528
  • Facility Name: TETON DERMATOLOGY, LLC DBA EPIPHANY DERMATOLOGY
  • Facility Address: 625 HENNICK STREET
    PINEDALE, WY
    ZIP 82941
  • Facility Phone: 307 734-1800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBIN C. SPROULE
  • NPI Number: 1194044750
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 53D2311528
LAB Type Physician Office
Facility Name TETON DERMATOLOGY, LLC DBA EPIPHANY DERMATOLOGY
Street 625 HENNICK STREET
City PINEDALE
State WY
ZIP 82941
Phone 307 734-1800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/24/2024
Certificate Expiration Date 9/23/2026
Facility Type Physician Office
Lab Director ROBIN C. SPROULE

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