16D1084332 CLIA NUMBER - WEST BROADWAY CLINIC, PC

Laboratory Demographics

  • CLIA Code: 16D1084332
  • Facility Name: WEST BROADWAY CLINIC, PC
  • Facility Address: 1701 WEST BROADWAY
    COUNCIL BLUFFS, IA
    ZIP 51501
  • Facility Phone: 712 256-5600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ISAM E. MARAR
  • NPI Number: 1447641618
  • Taxonomy: 363AM0700X - Physician Assistant

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CLIA Record

Field Name Field Value
CLIA Number 16D1084332
LAB Type Physician Office
Facility Name WEST BROADWAY CLINIC, PC
Street 1701 WEST BROADWAY
City COUNCIL BLUFFS
State IA
ZIP 51501
Phone 712 256-5600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/20/2024
Certificate Expiration Date 5/19/2026
Facility Type Physician Office
Lab Director ISAM E. MARAR

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