28D2191027 CLIA NUMBER - ADVANCED DERMATOLOGY AND SKIN CANCER CENTER PA DBA DBA PREMIER DERMATOLOGY SKIN CANCER SPECIALTIES PC

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Laboratory Demographics

CLIA Number: 28D2191027

Facility Name: ADVANCED DERMATOLOGY AND SKIN CANCER CENTER PA DBA DBA PREMIER DERMATOLOGY SKIN CANCER SPECIALTIES PC

Facility Address:
820 N WEBB ROAD SUITE 104
GRAND ISLAND, NE
ZIP 68803
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Facility Phone Number: 308 384-0133

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1306881800

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	28D2191027
LAB Type	Physician Office
Facility Name	ADVANCED DERMATOLOGY AND SKIN CANCER CENTER PA DBA DBA PREMIER DERMATOLOGY SKIN CANCER SPECIALTIES PC
Street	820 N WEBB ROAD SUITE 104
City	GRAND ISLAND
State	NE
ZIP	68803
Phone	308 384-0133
CertificateType	2
CertificateEffectiveDate	2/11/2023
CertificateExpirationDate	2/10/2025
FacilityType	Compliance

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