17D2165531 CLIA NUMBER - WICHITA PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 17D2165531
  • Facility Name: WICHITA PRIMARY CARE
  • Facility Address: 2230 N RIDGE ROAD
    WICHITA, KS
    ZIP 67205
  • Facility Phone: 316 448-8339
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HEIDI D. LARISON
  • NPI Number: 1164908281
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 17D2165531
LAB Type Physician Office
Facility Name WICHITA PRIMARY CARE
Street 2230 N RIDGE ROAD
City WICHITA
State KS
ZIP 67205
Phone 316 448-8339
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/30/2025
Certificate Expiration Date 4/29/2027
Facility Type Physician Office
Lab Director HEIDI D. LARISON

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