16D2304947 CLIA NUMBER - GENESIS HEALTH GROUP, DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 16D2304947
  • Facility Name: GENESIS HEALTH GROUP, DERMATOLOGY
  • Facility Address: 4700 E 56TH ST
    DAVENPORT, IA
    ZIP 52807
  • Facility Phone: 563 421-9100
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JENNIFER L. PRATHER
  • NPI Number: 1558477794
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 16D2304947
LAB Type Physician Office
Facility Name GENESIS HEALTH GROUP, DERMATOLOGY
Street 4700 E 56TH ST
City DAVENPORT
State IA
ZIP 52807
Phone 563 421-9100
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 2/1/2025
Certificate Expiration Date 1/31/2027
Facility Type Physician Office
Lab Director JENNIFER L. PRATHER

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This page was last updated on: 6/4/2025