17D1055450 CLIA NUMBER - COSMETIC & RECONSTRUCTIVE SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 17D1055450
  • Facility Name: COSMETIC & RECONSTRUCTIVE SURGERY CENTER
  • Facility Address: 1700 WATERFRONT BLDG 200
    WICHITA, KS
    ZIP 67206
  • Facility Phone: 316 681-2227
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: MATTHEW H. CONRAD, MD
  • NPI Number: 1659327245
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 17D1055450
LAB Type Ambulatory Surgery Center
Facility Name COSMETIC & RECONSTRUCTIVE SURGERY CENTER
Street 1700 WATERFRONT BLDG 200
City WICHITA
State KS
ZIP 67206
Phone 316 681-2227
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/19/2024
Certificate Expiration Date 6/18/2026
Facility Type Ambulatory Surgery Center
Lab Director MATTHEW H. CONRAD, MD

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