17D0880920 CLIA NUMBER - PRATT INTERNAL MEDICINE GROUP

Laboratory Demographics

  • CLIA Code: 17D0880920
  • Facility Name: PRATT INTERNAL MEDICINE GROUP
  • Facility Address: 420 COUNTRY CLUB ROAD
    PRATT, KS
    ZIP 67124
  • Facility Phone: (620) 672-7411
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JASSPER PAULIN
  • NPI Number: 1174570386
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 17D0880920
LAB Type Physician Office
Facility Name PRATT INTERNAL MEDICINE GROUP
Street 420 COUNTRY CLUB ROAD
City PRATT
State KS
ZIP 67124
Phone 6206727411
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/30/2025
Certificate Expiration Date 12/29/2027
Facility Type Physician Office
Lab Director JASSPER PAULIN

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This page was last updated on: 5/18/2026