17D2110681 CLIA NUMBER - ANTIOCH MED LLC

Laboratory Demographics

  • CLIA Code: 17D2110681
  • Facility Name: ANTIOCH MED LLC
  • Facility Address: 1126 S CLIFTON AVENUE
    WICHITA, KS
    ZIP 67218
  • Facility Phone: 316 350-8008
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NICHOLAS TOMSEN
  • NPI Number: 1629895008
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 17D2110681
LAB Type Physician Office
Facility Name ANTIOCH MED LLC
Street 1126 S CLIFTON AVENUE
City WICHITA
State KS
ZIP 67218
Phone 316 350-8008
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2024
Certificate Expiration Date 3/21/2026
Facility Type Physician Office
Lab Director NICHOLAS TOMSEN

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