16D1072573 CLIA NUMBER - SHENANDOAH MEDICAL CENTER DBA SHENANDOAH PHYSICIANS CLINIC - ESSEX

Laboratory Demographics

CLIA Number: 16D1072573

Facility Name: SHENANDOAH MEDICAL CENTER DBA SHENANDOAH PHYSICIANS CLINIC - ESSEX

Facility Address:
527 IOWA AVENUE, PO BOX 539
ESSEX, IA
ZIP 51638
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Facility Phone Number: 712 246-7106

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1558766956

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	16D1072573
LAB Type	Physician Office
Facility Name	SHENANDOAH MEDICAL CENTER DBA SHENANDOAH PHYSICIANS CLINIC - ESSEX
Street	527 IOWA AVENUE, PO BOX 539
City	ESSEX
State	IA
ZIP	51638
Phone	712 246-7106
CertificateType	3
CertificateEffectiveDate	8/20/2023
CertificateExpirationDate	8/19/2025
FacilityType	PPMP

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