26D0901796 CLIA NUMBER - NORTHSIDE PED & ADOLESCENT

Laboratory Demographics

  • CLIA Code: 26D0901796
  • Facility Name: NORTHSIDE PED & ADOLESCENT
  • Facility Address: 1443 N ROBBERSON AVE STE 200
    SPRINGFIELD, MO
    ZIP 65802
  • Facility Phone: 417 269-8061
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KELLY D. WRIGHT
  • NPI Number: 1134295868
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 26D0901796
LAB Type Physician Office
Facility Name NORTHSIDE PED & ADOLESCENT
Street 1443 N ROBBERSON AVE STE 200
City SPRINGFIELD
State MO
ZIP 65802
Phone 417 269-8061
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/29/2023
Certificate Expiration Date 11/28/2025
Facility Type Physician Office
Lab Director KELLY D. WRIGHT

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