17D0690043 CLIA NUMBER - MEDICALODGE SOUTH

Laboratory Demographics

  • CLIA Code: 17D0690043
  • Facility Name: MEDICALODGE SOUTH
  • Facility Address: 2520 S ROUSE
    PITTSBURG, KS
    ZIP 66762
  • Facility Phone: 620 231-0300
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JULIE O'HARA, RN
  • NPI Number: 1780771717
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 17D0690043
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MEDICALODGE SOUTH
Street 2520 S ROUSE
City PITTSBURG
State KS
ZIP 66762
Phone 620 231-0300
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 Skilled Nursing Facility/Nursing Facility
Lab Director JULIE O'HARA, RN

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