16D2235485 CLIA NUMBER - PROACTIVE MD- CF PORT NEAL HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 16D2235485
  • Facility Name: PROACTIVE MD- CF PORT NEAL HEALTH CENTER
  • Facility Address: 1182 260TH ST
    SERGEANT BLUFF, IA
    ZIP 51054
  • Facility Phone: 712 317-1130
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: ANGELA ANDERSON
  • NPI Number: 1922777465
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 16D2235485
LAB Type Practitioner Other
Facility Name PROACTIVE MD- CF PORT NEAL HEALTH CENTER
Street 1182 260TH ST
City SERGEANT BLUFF
State IA
ZIP 51054
Phone 712 317-1130
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/9/2025
Certificate Expiration Date 9/8/2027
Facility Type Practitioner Other
Lab Director ANGELA ANDERSON

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