17D0450579 CLIA NUMBER - WILSON COUNTY HOSPITAL DBA NEODESHA FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 17D0450579
  • Facility Name: WILSON COUNTY HOSPITAL DBA NEODESHA FAMILY MEDICINE
  • Facility Address: 2600 OTTAWA ROAD
    NEODESHA, KS
    ZIP 66757
  • Facility Phone: 620 325-2622
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: BRADLEY BARRETT
  • NPI Number: 1639699309
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 17D0450579
LAB Type Rural Health Clinic
Facility Name WILSON COUNTY HOSPITAL DBA NEODESHA FAMILY MEDICINE
Street 2600 OTTAWA ROAD
City NEODESHA
State KS
ZIP 66757
Phone 620 325-2622
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Rural Health Clinic
Lab Director BRADLEY BARRETT

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