17D1006693 CLIA NUMBER - EL DORADO CORRECTIONAL FACILITY

Laboratory Demographics

CLIA Number: 17D1006693

Facility Name: EL DORADO CORRECTIONAL FACILITY

Facility Address:
1737 SE HIGHWAY 54 PO BOX 311
EL DORADO, KS
ZIP 67042
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Facility Phone Number: 785 227-9792

Facility Type: Prison

Certificate Type: Waiver

NPI Number: 1609246404

Taxonomy: 1223G0001X - Dentist
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

CLIA Record

Field Name	Field Value
CLIA Number	17D1006693
LAB Type	Prison
Facility Name	EL DORADO CORRECTIONAL FACILITY
Street	1737 SE HIGHWAY 54 PO BOX 311
City	EL DORADO
State	KS
ZIP	67042
Phone	785 227-9792
CertificateType	4
CertificateEffectiveDate	11/26/2022
CertificateExpirationDate	11/25/2024
FacilityType	Waiver

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