26D0917611 CLIA NUMBER - OZARKS HEALTHCARE - FAMILY MEDICINE WALK-IN CLINIC

Laboratory Demographics

CLIA Number: 26D0917611

Facility Name: OZARKS HEALTHCARE - FAMILY MEDICINE WALK-IN CLINIC

Facility Address:
181 KENTUCKY AVE
WEST PLAINS, MO
ZIP 65775
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Facility Phone Number: 417 257-5972

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1649306119

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D0917611
LAB Type	Rural Health Clinic
Facility Name	OZARKS HEALTHCARE - FAMILY MEDICINE WALK-IN CLINIC
Street	181 KENTUCKY AVE
City	WEST PLAINS
State	MO
ZIP	65775
Phone	417 257-5972
CertificateType	4
CertificateEffectiveDate	9/15/2022
CertificateExpirationDate	9/14/2024
FacilityType	Waiver

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