53D2092856 CLIA NUMBER - JORDAN VALLEY DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 53D2092856
  • Facility Name: JORDAN VALLEY DERMATOLOGY
  • Facility Address: 428 SOUTH DURBIN SUITE 103
    CASPER, WY
    ZIP 82601
  • Facility Phone: 307 265-2936
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: VIRGINIA L. TUBBS
  • NPI Number: 1073954913
  • Taxonomy: 174400000X - Specialist

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 53D2092856
LAB Type Physician Office
Facility Name JORDAN VALLEY DERMATOLOGY
Street 428 SOUTH DURBIN SUITE 103
City CASPER
State WY
ZIP 82601
Phone 307 265-2936
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/16/2025
Certificate Expiration Date 3/15/2027
Facility Type Physician Office
Lab Director VIRGINIA L. TUBBS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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