17D2067435 CLIA NUMBER - GUADALUPE CLINIC, INC

Laboratory Demographics

  • CLIA Code: 17D2067435
  • Facility Name: GUADALUPE CLINIC, INC
  • Facility Address: 940 SOUTH ST FRANCIS
    WICHITA, KS
    ZIP 67211
  • Facility Phone: 316 264-6464
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: JENNIFER LARSEN
  • NPI Number: 1710144985
  • Taxonomy: 251V00000X - Voluntary or Charitable

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CLIA Record

Field Name Field Value
CLIA Number 17D2067435
LAB Type Community Clinic
Facility Name GUADALUPE CLINIC, INC
Street 940 SOUTH ST FRANCIS
City WICHITA
State KS
ZIP 67211
Phone 316 264-6464
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/15/2025
Certificate Expiration Date 10/14/2027
Facility Type Community Clinic
Lab Director JENNIFER LARSEN

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