53D2313176 CLIA NUMBER - 307 LONGEVITY DBA THE LEGACY CLINIC

Laboratory Demographics

  • CLIA Code: 53D2313176
  • Facility Name: 307 LONGEVITY DBA THE LEGACY CLINIC
  • Facility Address: 1120 BECK AVE
    CODY, WY
    ZIP 82414
  • Facility Phone: 307 527-0355
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THOMA F. CHRISTOPHER
  • NPI Number: 1316783673
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 53D2313176
LAB Type Physician Office
Facility Name 307 LONGEVITY DBA THE LEGACY CLINIC
Street 1120 BECK AVE
City CODY
State WY
ZIP 82414
Phone 307 527-0355
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/25/2024
Certificate Expiration Date 10/24/2026
Facility Type Physician Office
Lab Director THOMA F. CHRISTOPHER

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