17D0676947 CLIA NUMBER - MEDICALODGE OF PAOLA

Laboratory Demographics

  • CLIA Code: 17D0676947
  • Facility Name: MEDICALODGE OF PAOLA
  • Facility Address: 501 ASSEMBLY LANE
    PAOLA, KS
    ZIP 66071
  • Facility Phone: 913 294-3345
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: BREANNA A. BISHOP DON RN
  • NPI Number: 1417045139
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 17D0676947
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name MEDICALODGE OF PAOLA
Street 501 ASSEMBLY LANE
City PAOLA
State KS
ZIP 66071
Phone 913 294-3345
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director BREANNA A. BISHOP DON RN

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