17D2072303 CLIA NUMBER - EAGLEMED

Laboratory Demographics

  • CLIA Code: 17D2072303
  • Facility Name: EAGLEMED
  • Facility Address: 6601 WEST PUEBLO DRIVE
    WICHITA, KS
    ZIP 67209
  • Facility Phone: 316 613-4879
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: CRAIG ISOM
  • NPI Number: 1790787430
  • Taxonomy: 3416A0800X - Ambulance

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 17D2072303
LAB Type Ambulance
Facility Name EAGLEMED
Street 6601 WEST PUEBLO DRIVE
City WICHITA
State KS
ZIP 67209
Phone 316 613-4879
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/28/2024
Certificate Expiration Date 1/27/2026
Facility Type Ambulance
Lab Director CRAIG ISOM

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