17D2263210 CLIA NUMBER - MED-TRANS GREAT BEND

Laboratory Demographics

CLIA Number: 17D2263210

Facility Name: MED-TRANS GREAT BEND

Facility Address:
9025 4TH ST, BLDG A
GREAT BEND, KS
ZIP 67530
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Facility Phone Number: 620 200-2783

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1386382356

Taxonomy: 3416A0800X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	17D2263210
LAB Type	Ambulance
Facility Name	MED-TRANS GREAT BEND
Street	9025 4TH ST, BLDG A
City	GREAT BEND
State	KS
ZIP	67530
Phone	620 200-2783
CertificateType	4
CertificateEffectiveDate	6/24/2022
CertificateExpirationDate	6/23/2024
FacilityType	Waiver

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