17D2126513 CLIA NUMBER - ESSENTIAL HEALTH & WELLNESS LLC

Laboratory Demographics

CLIA Number: 17D2126513

Facility Name: ESSENTIAL HEALTH & WELLNESS LLC

Facility Address:
1001 N BUCKNER ST
DERBY, KS
ZIP 67037
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Facility Phone Number: 316 425-3337

Facility Type: Independent

Certificate Type: Waiver

NPI Number: 1528502812

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	17D2126513
LAB Type	Independent
Facility Name	ESSENTIAL HEALTH & WELLNESS LLC
Street	1001 N BUCKNER ST
City	DERBY
State	KS
ZIP	67037
Phone	316 425-3337
CertificateType	4
CertificateEffectiveDate	2/28/2023
CertificateExpirationDate	2/27/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024