17D0452730 CLIA NUMBER - UKHS ST ROSE MEDICAL PAVILION

Laboratory Demographics

  • CLIA Code: 17D0452730
  • Facility Name: UKHS ST ROSE MEDICAL PAVILION
  • Facility Address: 3515 BROADWAY AVE, FLOORS 1 & 3
    GREAT BEND, KS
    ZIP 67530
  • Facility Phone: 620 792-2511
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: KYLE A. ZINK
  • NPI Number: 1992272918
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 17D0452730
LAB Type Rural Health Clinic
Facility Name UKHS ST ROSE MEDICAL PAVILION
Street 3515 BROADWAY AVE, FLOORS 1 & 3
City GREAT BEND
State KS
ZIP 67530
Phone 620 792-2511
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/8/2024
Certificate Expiration Date 9/7/2026
Facility Type Rural Health Clinic
Lab Director KYLE A. ZINK

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