16D2301537 CLIA NUMBER - CORRIDOR KETAMINE, LLC

Laboratory Demographics

  • CLIA Code: 16D2301537
  • Facility Name: CORRIDOR KETAMINE, LLC
  • Facility Address: 1900 JAMES ST
    CORALVILLE, IA
    ZIP 52241
  • Facility Phone: 319 337-8329
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: TRENT SASSMAN
  • NPI Number: 1356099154
  • Taxonomy: 367500000X - Nurse Anesthetist, Certified Registered

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CLIA Record

Field Name Field Value
CLIA Number 16D2301537
LAB Type Practitioner Other
Facility Name CORRIDOR KETAMINE, LLC
Street 1900 JAMES ST
City CORALVILLE
State IA
ZIP 52241
Phone 319 337-8329
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/27/2024
Certificate Expiration Date 3/26/2026
Facility Type Practitioner Other
Lab Director TRENT SASSMAN

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