16D2130965 CLIA NUMBER - VILLAGE CLINIC, LLC, THE

Laboratory Demographics

  • CLIA Code: 16D2130965
  • Facility Name: VILLAGE CLINIC, LLC, THE
  • Facility Address: 2107 EAST 12TH ST
    DAVENPORT, IA
    ZIP 52803
  • Facility Phone: 563 499-0437
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: AMANDA DISCH
  • NPI Number: 1669902755
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 16D2130965
LAB Type Physician Office
Facility Name VILLAGE CLINIC, LLC, THE
Street 2107 EAST 12TH ST
City DAVENPORT
State IA
ZIP 52803
Phone 563 499-0437
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 5/19/2025
Certificate Expiration Date 5/18/2027
Facility Type Physician Office
Lab Director AMANDA DISCH

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