17D0676649 CLIA NUMBER - MEDICALODGE

Laboratory Demographics

CLIA Number: 17D0676649

Facility Name: MEDICALODGE

Facility Address:
915 S HORTON
FORT SCOTT, KS
ZIP 66701
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Facility Phone Number: 620 223-0210

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver

NPI Number: 1720040744

Taxonomy: 314000000X - Skilled Nursing Facility
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

CLIA Record

Field Name	Field Value
CLIA Number	17D0676649
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	MEDICALODGE
Street	915 S HORTON
City	FORT SCOTT
State	KS
ZIP	66701
Phone	620 223-0210
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024