17D0679487 CLIA NUMBER - ELLSWORTH CORRECTIONAL FACILITY CENTURION LLC

Laboratory Demographics

  • CLIA Code: 17D0679487
  • Facility Name: ELLSWORTH CORRECTIONAL FACILITY CENTURION LLC
  • Facility Address: 1607 STATE PO BOX 107
    ELLSWORTH, KS
    ZIP 67439
  • Facility Phone: 785 227-9792
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: BRYAN D. WILSON
  • NPI Number: 1689674657
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 17D0679487
LAB Type Prison
Facility Name ELLSWORTH CORRECTIONAL FACILITY CENTURION LLC
Street 1607 STATE PO BOX 107
City ELLSWORTH
State KS
ZIP 67439
Phone 785 227-9792
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 Prison
Lab Director BRYAN D. WILSON

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