17D1004131 CLIA NUMBER - OLATHE HEALTH FAMILY MEDICINE LOUISBURG

Laboratory Demographics

CLIA Number: 17D1004131

Facility Name: OLATHE HEALTH FAMILY MEDICINE LOUISBURG

Facility Address:
102 W CRESTVIEW CIR
LOUISBURG, KS
ZIP 66053
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Facility Phone Number: 913 837-4299

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1750887972

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	17D1004131
LAB Type	Rural Health Clinic
Facility Name	OLATHE HEALTH FAMILY MEDICINE LOUISBURG
Street	102 W CRESTVIEW CIR
City	LOUISBURG
State	KS
ZIP	66053
Phone	913 837-4299
CertificateType	4
CertificateEffectiveDate	1/1/2023
CertificateExpirationDate	12/31/2024
FacilityType	Waiver

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