16D0667913 CLIA NUMBER - TRI-STATE FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 16D0667913
  • Facility Name: TRI-STATE FAMILY PRACTICE
  • Facility Address: 1500 DELHI STREET, SUITE 4100
    DUBUQUE, IA
    ZIP 52001
  • Facility Phone: 563 557-5900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL D. MCKENNA
  • NPI Number: 1699723775
  • Taxonomy: 173000000X - Legal Medicine

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director MICHAEL D. MCKENNA

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