17D1079743 CLIA NUMBER - BON NOLA MD, LLC

Laboratory Demographics

  • CLIA Code: 17D1079743
  • Facility Name: BON NOLA MD, LLC
  • Facility Address: 804 S OLIVER AVE
    WICHITA, KS
    ZIP 67218
  • Facility Phone: 316 689-6004
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BON NOLA
  • NPI Number: 1275715534
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 17D1079743
LAB Type Physician Office
Facility Name BON NOLA MD, LLC
Street 804 S OLIVER AVE
City WICHITA
State KS
ZIP 67218
Phone 316 689-6004
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/6/2024
Certificate Expiration Date 2/5/2026
Facility Type Physician Office
Lab Director BON NOLA

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