53D2203437 CLIA NUMBER - JACKSON PEDIATRIC ASSOCIATES LLC

Laboratory Demographics

  • CLIA Code: 53D2203437
  • Facility Name: JACKSON PEDIATRIC ASSOCIATES LLC
  • Facility Address: 505 E BROADWAY AVE
    JACKSON, WY
    ZIP 83001
  • Facility Phone: 307 733-4627
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TRAVIS RIDDELL
  • NPI Number: 1316158272
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 53D2203437
LAB Type Physician Office
Facility Name JACKSON PEDIATRIC ASSOCIATES LLC
Street 505 E BROADWAY AVE
City JACKSON
State WY
ZIP 83001
Phone 307 733-4627
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2024
Certificate Expiration Date 12/2/2026
Facility Type Physician Office
Lab Director TRAVIS RIDDELL

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