17D0996594 CLIA NUMBER - MEDICALODGES INDEPENDENCE

Laboratory Demographics

  • CLIA Code: 17D0996594
  • Facility Name: MEDICALODGES INDEPENDENCE
  • Facility Address: 1000 MULBERRY
    INDEPENDENCE, KS
    ZIP 67301
  • Facility Phone: 620 331-8789
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: STACI CLUBINE, RN
  • NPI Number: 1346678224
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 17D0996594
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MEDICALODGES INDEPENDENCE
Street 1000 MULBERRY
City INDEPENDENCE
State KS
ZIP 67301
Phone 620 331-8789
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/21/2024
Certificate Expiration Date 2/20/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director STACI CLUBINE, RN

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