53D0879634 CLIA NUMBER - FAMILY CLINIC,THE

Laboratory Demographics

  • CLIA Code: 53D0879634
  • Facility Name: FAMILY CLINIC,THE
  • Facility Address: 1315 EAST A STREET
    CASPER, WY
    ZIP 82601
  • Facility Phone: 307 235-8552
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DANA R. IDEEN
  • NPI Number: 1871629832
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 53D0879634
LAB Type Physician Office
Facility Name FAMILY CLINIC,THE
Street 1315 EAST A STREET
City CASPER
State WY
ZIP 82601
Phone 307 235-8552
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/30/2023
Certificate Expiration Date 11/29/2025
Facility Type Physician Office
Lab Director DANA R. IDEEN

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