17D2318708 CLIA NUMBER - BLUE VALLEY DERMATOLOGY LENEXA

Laboratory Demographics

  • CLIA Code: 17D2318708
  • Facility Name: BLUE VALLEY DERMATOLOGY LENEXA
  • Facility Address: 12210 W 87TH STREET, STE 180
    LENEXA, KS
    ZIP 66215
  • Facility Phone: 913 871-8221
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: LAUREN A. KYLE TKACHUK
  • NPI Number: 1396936928
  • Taxonomy: 261QR0208X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 17D2318708
LAB Type Physician Office
Facility Name BLUE VALLEY DERMATOLOGY LENEXA
Street 12210 W 87TH STREET, STE 180
City LENEXA
State KS
ZIP 66215
Phone 913 871-8221
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 2/17/2025
Certificate Expiration Date 2/16/2027
Facility Type Physician Office
Lab Director LAUREN A. KYLE TKACHUK

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