43D0970407 CLIA NUMBER - ST LUKES OCCUPATIONAL MEDICINE CLINIC

Laboratory Demographics

CLIA Number: 43D0970407

Facility Name: ST LUKES OCCUPATIONAL MEDICINE CLINIC

Facility Address:
4230 WAR EAGLE DRIVE
SIOUX CITY, IA
ZIP 51109
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Facility Phone Number: 605 232-8782

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1396054581

Taxonomy: 261QX0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	43D0970407
LAB Type	Physician Office
Facility Name	ST LUKES OCCUPATIONAL MEDICINE CLINIC
Street	4230 WAR EAGLE DRIVE
City	SIOUX CITY
State	IA
ZIP	51109
Phone	605 232-8782
CertificateType	4
CertificateEffectiveDate	4/18/2024
CertificateExpirationDate	4/17/2026
FacilityType	Waiver

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