17D2058727 CLIA NUMBER - INDEPENDENCE FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 17D2058727
  • Facility Name: INDEPENDENCE FAMILY MEDICINE
  • Facility Address: 1415 N PENN AVE
    INDEPENDENCE, KS
    ZIP 67301
  • Facility Phone: 620 331-2400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRADLEY BARRETT
  • NPI Number: 1003251802
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 17D2058727
LAB Type Physician Office
Facility Name INDEPENDENCE FAMILY MEDICINE
Street 1415 N PENN AVE
City INDEPENDENCE
State KS
ZIP 67301
Phone 620 331-2400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/10/2025
Certificate Expiration Date 5/9/2027
Facility Type Physician Office
Lab Director BRADLEY BARRETT

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