17D1051918 CLIA NUMBER - RUSSELL REGIONAL HOSPITAL PHYSICIAN'S CLINIC

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Laboratory Demographics

CLIA Number: 17D1051918

Facility Name: RUSSELL REGIONAL HOSPITAL PHYSICIAN'S CLINIC

Facility Address:
200 S MAIN BLDG B
RUSSELL, KS
ZIP 67665
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Facility Phone Number: 785 483-3333

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1215907951

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	17D1051918
LAB Type	Rural Health Clinic
Facility Name	RUSSELL REGIONAL HOSPITAL PHYSICIAN'S CLINIC
Street	200 S MAIN BLDG B
City	RUSSELL
State	KS
ZIP	67665
Phone	785 483-3333
CertificateType	4
CertificateEffectiveDate	3/14/2024
CertificateExpirationDate	3/13/2026
FacilityType	Waiver

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