17D0964323 CLIA NUMBER - FOWLER COMMUNITY CLINIC

Laboratory Demographics

CLIA Number: 17D0964323

Facility Name: FOWLER COMMUNITY CLINIC

Facility Address:
404 MAIN
FOWLER, KS
ZIP 67844
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Facility Phone Number: 620 646-5446

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1700975729

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	17D0964323
LAB Type	Community Clinic
Facility Name	FOWLER COMMUNITY CLINIC
Street	404 MAIN
City	FOWLER
State	KS
ZIP	67844
Phone	620 646-5446
CertificateType	3
CertificateEffectiveDate	8/23/2023
CertificateExpirationDate	8/22/2025
FacilityType	PPMP

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