17D0672188 CLIA NUMBER - DERMATOLOGY CLINIC

Laboratory Demographics

  • CLIA Code: 17D0672188
  • Facility Name: DERMATOLOGY CLINIC
  • Facility Address: 8404 W 13TH SUITE 220
    WICHITA, KS
    ZIP 67212
  • Facility Phone: 316 685-4395
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MARTHA S. HOUSHOLDER, MD

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 17D0672188
LAB Type Physician Office
Facility Name DERMATOLOGY CLINIC
Street 8404 W 13TH SUITE 220
City WICHITA
State KS
ZIP 67212
Phone 316 685-4395
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 Physician Office
Lab Director MARTHA S. HOUSHOLDER, MD

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 6/4/2025