26D1057110 CLIA NUMBER - SOONER INTERNAL MEDICINE LLC

Laboratory Demographics

  • CLIA Code: 26D1057110
  • Facility Name: SOONER INTERNAL MEDICINE LLC
  • Facility Address: 1002 MCINTOSH CIRCLE DRIVE, STE 1
    JOPLIN, MO
    ZIP 64804
  • Facility Phone: 417 781-0224
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RANDY E. BOWLES
  • NPI Number: 1154354835
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 26D1057110
LAB Type Physician Office
Facility Name SOONER INTERNAL MEDICINE LLC
Street 1002 MCINTOSH CIRCLE DRIVE, STE 1
City JOPLIN
State MO
ZIP 64804
Phone 417 781-0224
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/3/2024
Certificate Expiration Date 8/2/2026
Facility Type Physician Office
Lab Director RANDY E. BOWLES

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