02D0641335 CLIA NUMBER - GLACIER PEDIATRICS

Laboratory Demographics

  • CLIA Code: 02D0641335
  • Facility Name: GLACIER PEDIATRICS
  • Facility Address: 1600 GLACIER AVE
    JUNEAU, AK
    ZIP 99801
  • Facility Phone: 907 586-1542
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KENNETH W. MOSS
  • NPI Number: 1558500694
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 02D0641335
LAB Type Physician Office
Facility Name GLACIER PEDIATRICS
Street 1600 GLACIER AVE
City JUNEAU
State AK
ZIP 99801
Phone 907 586-1542
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/21/2023
Certificate Expiration Date 12/20/2025
Facility Type Physician Office
Lab Director KENNETH W. MOSS

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