17D1004438 CLIA NUMBER - CONWAY SPRINGS RURAL HEALTH CLINIC

Laboratory Demographics

  • CLIA Code: 17D1004438
  • Facility Name: CONWAY SPRINGS RURAL HEALTH CLINIC
  • Facility Address: 111 W SPRING
    CONWAY SPRINGS, KS
    ZIP 67031
  • Facility Phone: 620 456-2411
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: ETHAN LEAVITT
  • NPI Number: 1487712170
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 17D1004438
LAB Type Rural Health Clinic
Facility Name CONWAY SPRINGS RURAL HEALTH CLINIC
Street 111 W SPRING
City CONWAY SPRINGS
State KS
ZIP 67031
Phone 620 456-2411
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/26/2024
Certificate Expiration Date 9/25/2026
Facility Type Rural Health Clinic
Lab Director ETHAN LEAVITT

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