28D0886128 CLIA NUMBER - FULLERTON MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 28D0886128
  • Facility Name: FULLERTON MEDICAL CLINIC
  • Facility Address: 901 BROADWAY STREET
    FULLERTON, NE
    ZIP 68638
  • Facility Phone: 308 536-2458
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: DR. BLAKE A. COVER
  • NPI Number: 1124559901
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 28D0886128
LAB Type Rural Health Clinic
Facility Name FULLERTON MEDICAL CLINIC
Street 901 BROADWAY STREET
City FULLERTON
State NE
ZIP 68638
Phone 308 536-2458
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/1/2024
Certificate Expiration Date 4/30/2026
Facility Type Rural Health Clinic
Lab Director DR. BLAKE A. COVER

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