17D0949025 CLIA NUMBER - FAMILY MEDICINE GARDNER EDGERTON MEDICAL PAVILION

Laboratory Demographics

  • CLIA Code: 17D0949025
  • Facility Name: FAMILY MEDICINE GARDNER EDGERTON MEDICAL PAVILION
  • Facility Address: 29475 WEST 189TH TERRACE
    GARDNER, KS
    ZIP 66030
  • Facility Phone: 913 856-5577
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KATIE ALDIS
  • NPI Number: 1558879320
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 17D0949025
LAB Type Physician Office
Facility Name FAMILY MEDICINE GARDNER EDGERTON MEDICAL PAVILION
Street 29475 WEST 189TH TERRACE
City GARDNER
State KS
ZIP 66030
Phone 913 856-5577
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/21/2024
Certificate Expiration Date 7/20/2026
Facility Type Physician Office
Lab Director KATIE ALDIS

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