26D2103211 CLIA NUMBER - TRI-LAKES FAMILY CARE

Laboratory Demographics

CLIA Number: 26D2103211

Facility Name: TRI-LAKES FAMILY CARE

Facility Address:
1065 STATE HWY 248
BRANSON, MO
ZIP 65616
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Facility Phone Number: 417 332-3639

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1134500739

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	26D2103211
LAB Type	Physician Office
Facility Name	TRI-LAKES FAMILY CARE
Street	1065 STATE HWY 248
City	BRANSON
State	MO
ZIP	65616
Phone	417 332-3639
CertificateType	4
CertificateEffectiveDate	10/7/2023
CertificateExpirationDate	10/6/2025
FacilityType	Waiver

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