16D0385234 CLIA NUMBER - PRAIRIE PEDIATRICS & ADOLESCENT CLINIC PC

Laboratory Demographics

  • CLIA Code: 16D0385234
  • Facility Name: PRAIRIE PEDIATRICS & ADOLESCENT CLINIC PC
  • Facility Address: 1125 PIERCE STREET
    SIOUX CITY, IA
    ZIP 51105
  • Facility Phone: 712 255-8901
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. RAY C. STURDEVANT
  • NPI Number: 1306920319
  • Taxonomy: 2080P0202X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 16D0385234
LAB Type Physician Office
Facility Name PRAIRIE PEDIATRICS & ADOLESCENT CLINIC PC
Street 1125 PIERCE STREET
City SIOUX CITY
State IA
ZIP 51105
Phone 712 255-8901
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director DR. RAY C. STURDEVANT

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