17D1058544 CLIA NUMBER - ADVENTHEALTH PRIMARY CARE AT WELLSVILLE

Laboratory Demographics

CLIA Number: 17D1058544

Facility Name: ADVENTHEALTH PRIMARY CARE AT WELLSVILLE

Facility Address:
424 SOUTH MAIN STREET
WELLSVILLE, KS
ZIP 66092
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Facility Phone Number: 785 883-4863

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1043773591

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	17D1058544
LAB Type	Rural Health Clinic
Facility Name	ADVENTHEALTH PRIMARY CARE AT WELLSVILLE
Street	424 SOUTH MAIN STREET
City	WELLSVILLE
State	KS
ZIP	66092
Phone	785 883-4863
CertificateType	4
CertificateEffectiveDate	9/7/2022
CertificateExpirationDate	9/6/2024
FacilityType	Waiver

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