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17D0704165 CLIA NUMBER - ADVENTHEALTH MEDICAL GROUP PRIMARY CARE AT COLLEGE BOULEVARD

Laboratory Demographics

CLIA Number: 17D0704165

Facility Name: ADVENTHEALTH MEDICAL GROUP PRIMARY CARE AT COLLEGE BOULEVARD

Facility Address:
7025 COLLEGE BLVD. SUITE 200
OVERLAND PARK, KS
ZIP 66211
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Facility Phone Number: 913 338-4515

Facility Type: Physician Office

Certificate Type: Microscopy
NPI Number: 1952712168

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name Field Value
CLIA Number 17D0704165
LAB Type Physician Office
Facility Name ADVENTHEALTH MEDICAL GROUP PRIMARY CARE AT COLLEGE BOULEVARD
Street 7025 COLLEGE BLVD. SUITE 200
City OVERLAND PARK
State KS
ZIP 66211
Phone 913 338-4515
CertificateType 3
CertificateEffectiveDate 8/23/2022
CertificateExpirationDate 8/22/2024
FacilityType PPMP

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