17D0915738 CLIA NUMBER - UKHS GREAT BEND LLC DBA MEDICAL PAVILION

Laboratory Demographics

  • CLIA Code: 17D0915738
  • Facility Name: UKHS GREAT BEND LLC DBA MEDICAL PAVILION
  • Facility Address: 514 CLEVELAND STREET
    GREAT BEND, KS
    ZIP 67530
  • Facility Phone: (620) 792-2151
  • Facility Type: Rural Health Clinic
  • Facility Type: Microscopy
  • Lab Director: JODI E. HENRIKSON
  • NPI Number: 1073003992
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 17D0915738
LAB Type Rural Health Clinic
Facility Name UKHS GREAT BEND LLC DBA MEDICAL PAVILION
Street 514 CLEVELAND STREET
City GREAT BEND
State KS
ZIP 67530
Phone 6207922151
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/29/2025
Certificate Expiration Date 8/28/2027
Facility Type Rural Health Clinic
Lab Director JODI E. HENRIKSON

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