16D0951645 CLIA NUMBER - PRAIRIE PEDIATRICS AND ADOLESCENT CLINIC, PC

Laboratory Demographics

CLIA Number: 16D0951645

Facility Name: PRAIRIE PEDIATRICS AND ADOLESCENT CLINIC, PC

Facility Address:
2534 GLENN AVENUE
SIOUX CITY, IA
ZIP 51106
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Facility Phone Number: 712 274-7822

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1740491489

Taxonomy: 2080P0202X - Pediatrics
A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease.

CLIA Record

Field Name	Field Value
CLIA Number	16D0951645
LAB Type	Physician Office
Facility Name	PRAIRIE PEDIATRICS AND ADOLESCENT CLINIC, PC
Street	2534 GLENN AVENUE
City	SIOUX CITY
State	IA
ZIP	51106
Phone	712 274-7822
CertificateType	3
CertificateEffectiveDate	9/23/2022
CertificateExpirationDate	9/22/2024
FacilityType	PPMP

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