17D2159533 CLIA NUMBER - RURAL HEALTH RESOURCES OF JACKSON CO INC DBA HOLTON COMMUNITY HOSPITAL FAMILY PRACTICE ASSOC

Laboratory Demographics

CLIA Number: 17D2159533

Facility Name: RURAL HEALTH RESOURCES OF JACKSON CO INC DBA HOLTON COMMUNITY HOSPITAL FAMILY PRACTICE ASSOC

Facility Address:
323 2ND ST
WETMORE, KS
ZIP 66550
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Facility Phone Number: 785 886-4775

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1003152430

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	17D2159533
LAB Type	Rural Health Clinic
Facility Name	RURAL HEALTH RESOURCES OF JACKSON CO INC DBA HOLTON COMMUNITY HOSPITAL FAMILY PRACTICE ASSOC
Street	323 2ND ST
City	WETMORE
State	KS
ZIP	66550
Phone	785 886-4775
CertificateType	4
CertificateEffectiveDate	12/19/2022
CertificateExpirationDate	12/18/2024
FacilityType	Waiver

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