17D0451690 CLIA NUMBER - MEDICALODGE OF WICHITA

Laboratory Demographics

  • CLIA Code: 17D0451690
  • Facility Name: MEDICALODGE OF WICHITA
  • Facility Address: 2280 S MINNEAPOLIS
    WICHITA, KS
    ZIP 67211
  • Facility Phone: 316 265-5693
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: GRACE HUBBEL RN
  • NPI Number: 1841387008
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 17D0451690
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MEDICALODGE OF WICHITA
Street 2280 S MINNEAPOLIS
City WICHITA
State KS
ZIP 67211
Phone 316 265-5693
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 Skilled Nursing Facility/Nursing Facility
Lab Director GRACE HUBBEL RN

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