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CLIA Application for Certification (CMS-116)1. Complete the CLIA Application for Certification (CMS-116), in its entirety, for any of the following: · Initial Laboratory Certification · Change in Certification Type · Change in Provider Name · Change in Address, Telephone Number, etc. · Change in Laboratory Director2. Mail completed application to:
Wyoming CLIA Office: Healthcare Licensing and Surveys 6101 Yellowstone Rd, Ste 186C Cheyenne, WY 82002 Telephone: (307) 777-7123 Fax: (307) 777-7127
Not a Wyoming laboratory?
Refer to the Federal CLIA page for contact information in your state...