17D2144601 CLIA NUMBER - MEDLEN FAMILY CARE

Laboratory Demographics

CLIA Number: 17D2144601

Facility Name: MEDLEN FAMILY CARE

Facility Address:
609 BAPTISTE DR, SUITE A
PAOLA, KS
ZIP 66071
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Facility Phone Number: 913 338-3631

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1740781848

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	17D2144601
LAB Type	Practitioner Other
Facility Name	MEDLEN FAMILY CARE
Street	609 BAPTISTE DR, SUITE A
City	PAOLA
State	KS
ZIP	66071
Phone	913 338-3631
CertificateType	4
CertificateEffectiveDate	8/5/2022
CertificateExpirationDate	8/4/2024
FacilityType	Waiver

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