17D0452110 CLIA NUMBER - LABCORP KANSAS, INC - EAST 21ST STREET

Laboratory Demographics

  • CLIA Code: 17D0452110
  • Facility Name: LABCORP KANSAS, INC - EAST 21ST STREET
  • Facility Address: 9211 E 21ST STREET N
    WICHITA, KS
    ZIP 67206
  • Facility Phone: 316 274-4477
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JULIE J. SIMON
  • NPI Number: 1609514355
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 17D0452110
LAB Type Physician Office
Facility Name LABCORP KANSAS, INC - EAST 21ST STREET
Street 9211 E 21ST STREET N
City WICHITA
State KS
ZIP 67206
Phone 316 274-4477
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/28/2024
Certificate Expiration Date 7/27/2026
Facility Type Physician Office
Lab Director JULIE J. SIMON

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