16D0880650 CLIA NUMBER - FOX RIVER MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 16D0880650

Facility Name: FOX RIVER MEDICAL CLINIC

Facility Address:
14983 275TH STREET
CANTRIL, IA
ZIP 52542
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Facility Phone Number: 319 293-8720

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1578641593

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	16D0880650
LAB Type	Rural Health Clinic
Facility Name	FOX RIVER MEDICAL CLINIC
Street	14983 275TH STREET
City	CANTRIL
State	IA
ZIP	52542
Phone	319 293-8720
CertificateType	4
CertificateEffectiveDate	12/16/2023
CertificateExpirationDate	12/15/2025
FacilityType	Waiver

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