28D1089650 CLIA NUMBER - MID PLAINS PODIATRY, PC

Laboratory Demographics

CLIA Number: 28D1089650

Facility Name: MID PLAINS PODIATRY, PC

Facility Address:
2821 S 87TH AVE
OMAHA, NE
ZIP 68124
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Facility Phone Number: 402 315-4344

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1770739773

Taxonomy: 261QP1100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	28D1089650
LAB Type	Physician Office
Facility Name	MID PLAINS PODIATRY, PC
Street	2821 S 87TH AVE
City	OMAHA
State	NE
ZIP	68124
Phone	402 315-4344
CertificateType	4
CertificateEffectiveDate	9/23/2022
CertificateExpirationDate	9/22/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024