53D2266621 CLIA NUMBER - PAINTBRUSH PEDIATRICS, LC

Laboratory Demographics

  • CLIA Code: 53D2266621
  • Facility Name: PAINTBRUSH PEDIATRICS, LC
  • Facility Address: 555 EAST BROADWAY AVE, SUITE 202
    JACKSON, WY
    ZIP 83001
  • Facility Phone: 307 733-6520
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JACQUELIN F. HARDENBROOK
  • NPI Number: 1235862681
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 53D2266621
LAB Type Physician Office
Facility Name PAINTBRUSH PEDIATRICS, LC
Street 555 EAST BROADWAY AVE, SUITE 202
City JACKSON
State WY
ZIP 83001
Phone 307 733-6520
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/12/2024
Certificate Expiration Date 8/11/2026
Facility Type Physician Office
Lab Director JACQUELIN F. HARDENBROOK

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