28D2327118 CLIA NUMBER - MOD DERMATOLOGY BLACKSTONE

Laboratory Demographics

  • CLIA Code: 28D2327118
  • Facility Name: MOD DERMATOLOGY BLACKSTONE
  • Facility Address: 144 S 40TH ST
    OMAHA, NE
    ZIP 68131
  • Facility Phone: 402 505-8777
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MELANIE A. ORTLEB
  • NPI Number: 1982105425
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 28D2327118
LAB Type Physician Office
Facility Name MOD DERMATOLOGY BLACKSTONE
Street 144 S 40TH ST
City OMAHA
State NE
ZIP 68131
Phone 402 505-8777
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 7/16/2025
Certificate Expiration Date 7/15/2027
Facility Type Physician Office
Lab Director MELANIE A. ORTLEB

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