17D2200167 CLIA NUMBER - JONATHAN JACOBS, MD, LLC

Laboratory Demographics

  • CLIA Code: 17D2200167
  • Facility Name: JONATHAN JACOBS, MD, LLC
  • Facility Address: 5701 WEST 119 STREET, SUITE 240
    OVERLAND PARK, KS
    ZIP 66209
  • Facility Phone: 913 498-1444
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JONATHAN JACOBS
  • NPI Number: 1164458907
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 17D2200167
LAB Type Physician Office
Facility Name JONATHAN JACOBS, MD, LLC
Street 5701 WEST 119 STREET, SUITE 240
City OVERLAND PARK
State KS
ZIP 66209
Phone 913 498-1444
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/13/2024
Certificate Expiration Date 11/12/2026
Facility Type Physician Office
Lab Director JONATHAN JACOBS

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This page was last updated on: 6/4/2025