17D1081743 CLIA NUMBER - IMMEDIATE MEDICAL CARE, PA

Laboratory Demographics

CLIA Number: 17D1081743

Facility Name: IMMEDIATE MEDICAL CARE, PA

Facility Address:
4722 WEST KELLOGG
WICHITA, KS
ZIP 67209
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Facility Phone Number: 316 440-2565

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1821260183

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	17D1081743
LAB Type	Physician Office
Facility Name	IMMEDIATE MEDICAL CARE, PA
Street	4722 WEST KELLOGG
City	WICHITA
State	KS
ZIP	67209
Phone	316 440-2565
CertificateType	3
CertificateEffectiveDate	5/12/2024
CertificateExpirationDate	5/11/2026
FacilityType	PPMP

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