17D2317954 CLIA NUMBER - MEDICAL ON DEMAND LLC DBA MK PHYSICIANS ASSOCIATES

Laboratory Demographics

  • CLIA Code: 17D2317954
  • Facility Name: MEDICAL ON DEMAND LLC DBA MK PHYSICIANS ASSOCIATES
  • Facility Address: 10346 E STONEGATE LN, STE 100
    WICHITA, KS
    ZIP 67206
  • Facility Phone: 316 871-0995
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: JUSTIN L. GOODEN
  • NPI Number: 1518618958
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 17D2317954
LAB Type Mobile Laboratory
Facility Name MEDICAL ON DEMAND LLC DBA MK PHYSICIANS ASSOCIATES
Street 10346 E STONEGATE LN, STE 100
City WICHITA
State KS
ZIP 67206
Phone 316 871-0995
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/4/2025
Certificate Expiration Date 2/3/2027
Facility Type Mobile Laboratory
Lab Director JUSTIN L. GOODEN

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