26D2034142 CLIA NUMBER - LEE'S SUMMIT FAMILY CARE, LLC

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Laboratory Demographics

CLIA Number: 26D2034142

Facility Name: LEE'S SUMMIT FAMILY CARE, LLC

Facility Address:
3490 RALPH POWELL RD SUITEB
LEES SUMMIT, MO
ZIP 64064
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Facility Phone Number: 816 478-0111

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1043577257

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	26D2034142
LAB Type	Physician Office
Facility Name	LEE'S SUMMIT FAMILY CARE, LLC
Street	3490 RALPH POWELL RD SUITEB
City	LEES SUMMIT
State	MO
ZIP	64064
Phone	816 478-0111
CertificateType	4
CertificateEffectiveDate	12/16/2023
CertificateExpirationDate	12/15/2025
FacilityType	Waiver

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