17D0448072 CLIA NUMBER - AMBERWELL ATCHISON PRIMARY CARE

Laboratory Demographics

CLIA Number: 17D0448072

Facility Name: AMBERWELL ATCHISON PRIMARY CARE

Facility Address:
810 RAVEN HILL RD ATTN BRENDA LANGLEY, CLINIC NURSE MANAGER
ATCHISON, KS
ZIP 66002
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Facility Phone Number: 913 367-7300

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1104905033

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	17D0448072
LAB Type	Rural Health Clinic
Facility Name	AMBERWELL ATCHISON PRIMARY CARE
Street	810 RAVEN HILL RD ATTN BRENDA LANGLEY, CLINIC NURSE MANAGER
City	ATCHISON
State	KS
ZIP	66002
Phone	913 367-7300
CertificateType	4
CertificateEffectiveDate	7/25/2022
CertificateExpirationDate	7/24/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024