43D2263298 CLIA NUMBER - ADVANCED DERMATOLOGY OF THE BLACK HILLS, PC

Laboratory Demographics

  • CLIA Code: 43D2263298
  • Facility Name: ADVANCED DERMATOLOGY OF THE BLACK HILLS, PC
  • Facility Address: 710 SAINT ANNE STREET
    RAPID CITY, SD
    ZIP 57701
  • Facility Phone: 605 343-8000
  • Facility Type: Practitioner Other
  • Facility Type: Microscopy
  • Lab Director: MR. JONATHAN D. MEDECK
  • NPI Number: 1346389178
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 43D2263298
LAB Type Practitioner Other
Facility Name ADVANCED DERMATOLOGY OF THE BLACK HILLS, PC
Street 710 SAINT ANNE STREET
City RAPID CITY
State SD
ZIP 57701
Phone 605 343-8000
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 6/27/2024
Certificate Expiration Date 6/26/2026
Facility Type Practitioner Other
Lab Director MR. JONATHAN D. MEDECK

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