17D2105480 CLIA NUMBER - ROLLA MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 17D2105480
  • Facility Name: ROLLA MEDICAL CLINIC
  • Facility Address: 415 WASHINGTON
    ROLLA, KS
    ZIP 67954
  • Facility Phone: 620 697-2141
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: ROBERT CLARK
  • NPI Number: 1295268928
  • Taxonomy: 363A00000X - Physician Assistant

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CLIA Record

Field Name Field Value
CLIA Number 17D2105480
LAB Type Rural Health Clinic
Facility Name ROLLA MEDICAL CLINIC
Street 415 WASHINGTON
City ROLLA
State KS
ZIP 67954
Phone 620 697-2141
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/25/2023
Certificate Expiration Date 11/24/2025
Facility Type Rural Health Clinic
Lab Director ROBERT CLARK

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