17D0964941 CLIA NUMBER - MT OREAD FAMILY PRACTICE LABORATORY

Laboratory Demographics

  • CLIA Code: 17D0964941
  • Facility Name: MT OREAD FAMILY PRACTICE LABORATORY
  • Facility Address: 6265 ROCK CHALK DRIVE, SUITE 1100
    LAWRENCE, KS
    ZIP 66049
  • Facility Phone: 785 842-2082
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: THOMAS R. MARCELLINO MD
  • NPI Number: 1679980908
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 17D0964941
LAB Type Physician Office
Facility Name MT OREAD FAMILY PRACTICE LABORATORY
Street 6265 ROCK CHALK DRIVE, SUITE 1100
City LAWRENCE
State KS
ZIP 66049
Phone 785 842-2082
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 5/1/2025
Certificate Expiration Date 4/30/2027
Facility Type Physician Office
Lab Director THOMAS R. MARCELLINO MD

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