16D2317248 CLIA NUMBER - KEOTA FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 16D2317248
  • Facility Name: KEOTA FAMILY PRACTICE
  • Facility Address: 302 E BROADWAY AVE
    KEOTA, IA
    ZIP 52248
  • Facility Phone: 319 202-3843
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JACKIE K. MORGAN
  • NPI Number: 1003628751
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 16D2317248
LAB Type Practitioner Other
Facility Name KEOTA FAMILY PRACTICE
Street 302 E BROADWAY AVE
City KEOTA
State IA
ZIP 52248
Phone 319 202-3843
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/21/2025
Certificate Expiration Date 1/20/2027
Facility Type Practitioner Other
Lab Director JACKIE K. MORGAN

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