16D2094636 CLIA NUMBER - DERMATOLOGY PC

Laboratory Demographics

  • CLIA Code: 16D2094636
  • Facility Name: DERMATOLOGY PC
  • Facility Address: 2006 NORTH 4TH STREET, SUITE 100
    INDIANOLA, IA
    ZIP 50125
  • Facility Phone: 515 241-2000
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JOSHUA B. WILSON
  • NPI Number: 1790736353
  • Taxonomy: 207ND0101X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 16D2094636
LAB Type Physician Office
Facility Name DERMATOLOGY PC
Street 2006 NORTH 4TH STREET, SUITE 100
City INDIANOLA
State IA
ZIP 50125
Phone 515 241-2000
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 4/21/2025
Certificate Expiration Date 4/20/2027
Facility Type Physician Office
Lab Director JOSHUA B. WILSON

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