16D0667913 CLIA NUMBER - TRI-STATE FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 16D0667913

Facility Name: TRI-STATE FAMILY PRACTICE

Facility Address:
1500 DELHI STREET, SUITE 4100
DUBUQUE, IA
ZIP 52001
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Facility Phone Number: 563 557-5900

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1699723775

Taxonomy: 173000000X - Legal Medicine
The specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical examinations at crime scenes, performance of autopsies, giving of expert medical testimony in judicial proceedings, medical treatment of inmates of penal institutions, the practice of trauma medicine in law enforcement settings, and other clinical practice and medical science applications in the fields of law, law enforcement, and corrections.

CLIA Record

Field Name	Field Value
CLIA Number	16D0667913
LAB Type	Physician Office
Facility Name	TRI-STATE FAMILY PRACTICE
Street	1500 DELHI STREET, SUITE 4100
City	DUBUQUE
State	IA
ZIP	52001
Phone	563 557-5900
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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