28D2132142 CLIA NUMBER - SOUTH SIDE CONVENIENT CARE

Laboratory Demographics

  • CLIA Code: 28D2132142
  • Facility Name: SOUTH SIDE CONVENIENT CARE
  • Facility Address: 4115 HARRISON STREET
    BELLEVUE, NE
    ZIP 68147
  • Facility Phone: 402 932-0692
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SAMANTHA SENANAYAKA
  • NPI Number: 1679007249
  • Taxonomy: 363A00000X - Physician Assistant

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CLIA Record

Field Name Field Value
CLIA Number 28D2132142
LAB Type Physician Office
Facility Name SOUTH SIDE CONVENIENT CARE
Street 4115 HARRISON STREET
City BELLEVUE
State NE
ZIP 68147
Phone 402 932-0692
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/13/2025
Certificate Expiration Date 6/12/2027
Facility Type Physician Office
Lab Director SAMANTHA SENANAYAKA

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