26D0984553 CLIA NUMBER - JACKSON PRIMARY CARE LLC

Laboratory Demographics

  • CLIA Code: 26D0984553
  • Facility Name: JACKSON PRIMARY CARE LLC
  • Facility Address: 2685 EAST MAIN, STE A
    JACKSON, MO
    ZIP 63755
  • Facility Phone: 573 204-1400
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DEANNA M. SIEMER MD
  • NPI Number: 1790213676
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 26D0984553
LAB Type Physician Office
Facility Name JACKSON PRIMARY CARE LLC
Street 2685 EAST MAIN, STE A
City JACKSON
State MO
ZIP 63755
Phone 573 204-1400
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 6/12/2025
Certificate Expiration Date 6/11/2027
Facility Type Physician Office
Lab Director DEANNA M. SIEMER MD

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