17D2048879 CLIA NUMBER - PREMONITION HEALTH LLC

Laboratory Demographics

  • CLIA Code: 17D2048879
  • Facility Name: PREMONITION HEALTH LLC
  • Facility Address: 1431 SOUTH BLUFFVIEW DR, SUITE 210
    WICHITA, KS
    ZIP 67218
  • Facility Phone: 316 789-6149
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MATTHEW L. BEZZANT
  • NPI Number: 1164292090
  • Taxonomy: 207R00000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 17D2048879
LAB Type Physician Office
Facility Name PREMONITION HEALTH LLC
Street 1431 SOUTH BLUFFVIEW DR, SUITE 210
City WICHITA
State KS
ZIP 67218
Phone 316 789-6149
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/16/2024
Certificate Expiration Date 7/15/2026
Facility Type Physician Office
Lab Director MATTHEW L. BEZZANT

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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