16D0385408 CLIA NUMBER - MERCYONE PRIMGHAR FAMILY MEDICINE CLINIC

Laboratory Demographics

CLIA Number: 16D0385408

Facility Name: MERCYONE PRIMGHAR FAMILY MEDICINE CLINIC

Facility Address:
240 NORTH RERICK AVENUE PO BOX 477
PRIMGHAR, IA
ZIP 51245
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Facility Phone Number: 712 757-2045

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1851327563

Taxonomy: 282NC0060X - General Acute Care Hospital

CLIA Record

Field Name	Field Value
CLIA Number	16D0385408
LAB Type	Physician Office
Facility Name	MERCYONE PRIMGHAR FAMILY MEDICINE CLINIC
Street	240 NORTH RERICK AVENUE PO BOX 477
City	PRIMGHAR
State	IA
ZIP	51245
Phone	712 757-2045
CertificateType	4
CertificateEffectiveDate	7/1/2022
CertificateExpirationDate	6/30/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024