17D1019091 CLIA NUMBER - GRIDLEY MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 17D1019091
  • Facility Name: GRIDLEY MEDICAL CLINIC
  • Facility Address: 321 ATHERLY
    GRIDLEY, KS
    ZIP 66852
  • Facility Phone: 620 836-2915
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: JOHN SHELL
  • NPI Number: 1922003995
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 17D1019091
LAB Type Rural Health Clinic
Facility Name GRIDLEY MEDICAL CLINIC
Street 321 ATHERLY
City GRIDLEY
State KS
ZIP 66852
Phone 620 836-2915
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/10/2023
Certificate Expiration Date 11/9/2025
Facility Type Rural Health Clinic
Lab Director JOHN SHELL

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