52D2328791 CLIA NUMBER - VIDA, INC -

Laboratory Demographics

  • CLIA Code: 52D2328791
  • Facility Name: VIDA, INC -
  • Facility Address: 670 CORMIER RD
    GREEN BAY, WI
    ZIP 54304
  • Facility Phone: 920 731-4354
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: DR. JAMES GIBSON
  • NPI Number: 1164213336
  • Taxonomy: 106S00000X - Behavior Technician

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CLIA Record

Field Name Field Value
CLIA Number 52D2328791
LAB Type Community Clinic
Facility Name VIDA, INC -
Street 670 CORMIER RD
City GREEN BAY
State WI
ZIP 54304
Phone 920 731-4354
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/18/2025
Certificate Expiration Date 8/17/2027
Facility Type Community Clinic
Lab Director DR. JAMES GIBSON

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