17D0671176 CLIA NUMBER - WICHITA STATE UNIVERSITY STUDENT HEALTH SERVICE

Laboratory Demographics

CLIA Code: 17D0671176
Facility Name: WICHITA STATE UNIVERSITY STUDENT HEALTH SERVICE
Facility Address: 2060 N MID-CAMPUS DRIVE
WICHITA, KS
ZIP 67260
Facility Phone: (316) 978-4792
Facility Type: School/Student Health Service
Facility Type: Microscopy
Lab Director: DELANE H. VAUGHN
NPI Number: 1174019293
Taxonomy: 261QS1000X - Clinic/Center

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CLIA Record

Field Name	Field Value
CLIA Number	17D0671176
LAB Type	School/Student Health Service
Facility Name	WICHITA STATE UNIVERSITY STUDENT HEALTH SERVICE
Street	2060 N MID-CAMPUS DRIVE
City	WICHITA
State	KS
ZIP	67260
Phone	3169784792
Certificate Type	Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description	This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date	9/1/2024
Certificate Expiration Date	8/31/2026
Facility Type	School/Student Health Service
Lab Director	DELANE H. VAUGHN

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This page was last updated on: 5/18/2026