28D2228930 CLIA NUMBER - BOYS TOWN NATIONAL RESEARCH HOSPITAL LAKESIDE INTERNAL MED

Laboratory Demographics

CLIA Number: 28D2228930

Facility Name: BOYS TOWN NATIONAL RESEARCH HOSPITAL LAKESIDE INTERNAL MED

Facility Address:
16929 FRANCES ST SUITE 103
OMAHA, NE
ZIP 68130
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Facility Phone Number: 531 355-6051

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1528165644

Taxonomy: 261QR0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	28D2228930
LAB Type	Physician Office
Facility Name	BOYS TOWN NATIONAL RESEARCH HOSPITAL LAKESIDE INTERNAL MED
Street	16929 FRANCES ST SUITE 103
City	OMAHA
State	NE
ZIP	68130
Phone	531 355-6051
CertificateType	4
CertificateEffectiveDate	7/2/2023
CertificateExpirationDate	7/1/2025
FacilityType	Waiver

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