17D0880920 CLIA NUMBER - PRATT INTERNAL MEDICINE GROUP

Laboratory Demographics

CLIA Number: 17D0880920

Facility Name: PRATT INTERNAL MEDICINE GROUP

Facility Address:
420 COUNTRY CLUB ROAD
PRATT, KS
ZIP 67124
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Facility Phone Number: 620 672-7411

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1174570386

Taxonomy: 261QR1300X - Clinic/Center

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	620 672-7411
CertificateType	4
CertificateEffectiveDate	12/30/2023
CertificateExpirationDate	12/29/2025
FacilityType	Waiver

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