28D2249221 CLIA NUMBER - FRONTIER PEDIATRIC CARE LLC

Laboratory Demographics

  • CLIA Code: 28D2249221
  • Facility Name: FRONTIER PEDIATRIC CARE LLC
  • Facility Address: 8333 GLYNOAKS DR, STE 180
    LINCOLN, NE
    ZIP 68516
  • Facility Phone: 402 817-2116
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. PHILIP T. BOUCHER
  • NPI Number: 1598468449
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 28D2249221
LAB Type Physician Office
Facility Name FRONTIER PEDIATRIC CARE LLC
Street 8333 GLYNOAKS DR, STE 180
City LINCOLN
State NE
ZIP 68516
Phone 402 817-2116
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/19/2024
Certificate Expiration Date 1/18/2026
Facility Type Physician Office
Lab Director DR. PHILIP T. BOUCHER

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