16D2101751 CLIA NUMBER - NICK HILDRETH MEMORIAL CLINIC LLC

Laboratory Demographics

CLIA Number: 16D2101751

Facility Name: NICK HILDRETH MEMORIAL CLINIC LLC

Facility Address:
401 COURT STREET
ROCKWELL CITY, IA
ZIP 50579
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Facility Phone Number: 515 571-3144

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1689041329

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	16D2101751
LAB Type	Practitioner Other
Facility Name	NICK HILDRETH MEMORIAL CLINIC LLC
Street	401 COURT STREET
City	ROCKWELL CITY
State	IA
ZIP	50579
Phone	515 571-3144
CertificateType	4
CertificateEffectiveDate	9/9/2023
CertificateExpirationDate	9/8/2025
FacilityType	Waiver

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