28D1054208 CLIA NUMBER - PINE LAKE HEALTH, LLC

Laboratory Demographics

  • CLIA Code: 28D1054208
  • Facility Name: PINE LAKE HEALTH, LLC
  • Facility Address: 2611 S 70TH STREET
    LINCOLN, NE
    ZIP 68506
  • Facility Phone: 402 423-4200
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MATTHEW M. GLENN
  • NPI Number: 1417908666
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 28D1054208
LAB Type Physician Office
Facility Name PINE LAKE HEALTH, LLC
Street 2611 S 70TH STREET
City LINCOLN
State NE
ZIP 68506
Phone 402 423-4200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/7/2024
Certificate Expiration Date 6/6/2026
Facility Type Physician Office
Lab Director DR. MATTHEW M. GLENN

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