17D1096274 CLIA NUMBER - FORT SCOTT CBOC

Laboratory Demographics

  • CLIA Code: 17D1096274
  • Facility Name: FORT SCOTT CBOC
  • Facility Address: 902 HORTON STREET
    FORT SCOTT, KS
    ZIP 66701
  • Facility Phone: 620 223-8655
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Accreditation
  • Lab Director: DANIEL DIM
  • NPI Number: 1982726717
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 17D1096274
LAB Type Ambulatory Surgery Center
Facility Name FORT SCOTT CBOC
Street 902 HORTON STREET
City FORT SCOTT
State KS
ZIP 66701
Phone 620 223-8655
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 3/2/2009
Certificate Expiration Date 5/22/2026
Facility Type Ambulatory Surgery Center
Lab Director DANIEL DIM

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