17D0706490 CLIA NUMBER - OSWALDO C BACANI MD CHARTERED

Laboratory Demographics

  • CLIA Code: 17D0706490
  • Facility Name: OSWALDO C BACANI MD CHARTERED
  • Facility Address: 1525 MADISON ST, SUITE 3
    FREDONIA, KS
    ZIP 66736
  • Facility Phone: 620 378-3700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JENNIFER B. MCKENNEY
  • NPI Number: 1467565879
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 17D0706490
LAB Type Physician Office
Facility Name OSWALDO C BACANI MD CHARTERED
Street 1525 MADISON ST, SUITE 3
City FREDONIA
State KS
ZIP 66736
Phone 620 378-3700
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 Physician Office
Lab Director JENNIFER B. MCKENNEY

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