16D1055123 CLIA NUMBER - UNDERWOOD FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 16D1055123
  • Facility Name: UNDERWOOD FAMILY PRACTICE
  • Facility Address: 401 HIGHWAY STREET
    UNDERWOOD, IA
    ZIP 51576
  • Facility Phone: 712 566-9148
  • Facility Type: Practitioner Other
  • Facility Type: Microscopy
  • Lab Director: JACQUELINE R. SULLIVAN-OGG, ARNP
  • NPI Number: 1396768503
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 16D1055123
LAB Type Practitioner Other
Facility Name UNDERWOOD FAMILY PRACTICE
Street 401 HIGHWAY STREET
City UNDERWOOD
State IA
ZIP 51576
Phone 712 566-9148
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/9/2024
Certificate Expiration Date 6/8/2026
Facility Type Practitioner Other
Lab Director JACQUELINE R. SULLIVAN-OGG, ARNP

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