17D2206563 CLIA NUMBER - MAUCK MEDICAL CLINIC, LLC

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Laboratory Demographics

CLIA Number: 17D2206563

Facility Name: MAUCK MEDICAL CLINIC, LLC

Facility Address:
907 PINE AVE, SUITE D
HOXIE, KS
ZIP 67740
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Facility Phone Number: 785 677-3930

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1467042895

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	17D2206563
LAB Type	Practitioner Other
Facility Name	MAUCK MEDICAL CLINIC, LLC
Street	907 PINE AVE, SUITE D
City	HOXIE
State	KS
ZIP	67740
Phone	785 677-3930
CertificateType	4
CertificateEffectiveDate	12/21/2022
CertificateExpirationDate	12/20/2024
FacilityType	Waiver

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