16D2057256 CLIA NUMBER - PREMIER DERMATOLOGY, LTD

Laboratory Demographics

  • CLIA Code: 16D2057256
  • Facility Name: PREMIER DERMATOLOGY, LTD
  • Facility Address: 3741 PHEASANT LANE
    WATERLOO, IA
    ZIP 50701
  • Facility Phone: 319 234-6000
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: JUSTIN C. ELLERBROEK
  • NPI Number: 1467898007
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 16D2057256
LAB Type Physician Office
Facility Name PREMIER DERMATOLOGY, LTD
Street 3741 PHEASANT LANE
City WATERLOO
State IA
ZIP 50701
Phone 319 234-6000
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 12/17/2023
Certificate Expiration Date 12/16/2025
Facility Type Physician Office
Lab Director JUSTIN C. ELLERBROEK

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This page was last updated on: 6/4/2025