28D1055422 CLIA NUMBER - PHELPS MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 28D1055422
  • Facility Name: PHELPS MEDICAL GROUP
  • Facility Address: 1315 TIBBALS STREET
    HOLDREGE, NE
    ZIP 68949
  • Facility Phone: 308 995-6111
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MR. BRADLEE C. HARTZOG
  • NPI Number: 1891189809
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 28D1055422
LAB Type Physician Office
Facility Name PHELPS MEDICAL GROUP
Street 1315 TIBBALS STREET
City HOLDREGE
State NE
ZIP 68949
Phone 308 995-6111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2023
Certificate Expiration Date 10/31/2025
Facility Type Physician Office
Lab Director MR. BRADLEE C. HARTZOG

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