26D2136197 CLIA NUMBER - CENTERWELL SENIOR PRIMARY CARE- INDEPENDENCE

Laboratory Demographics

  • CLIA Code: 26D2136197
  • Facility Name: CENTERWELL SENIOR PRIMARY CARE- INDEPENDENCE
  • Facility Address: 19401 EAST 39 STREET
    INDEPENDENCE, MO
    ZIP 64057
  • Facility Phone: 816 490-4277
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STEPHANIE IKEME
  • NPI Number: 1649793001
  • Taxonomy: 207R00000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 26D2136197
LAB Type Physician Office
Facility Name CENTERWELL SENIOR PRIMARY CARE- INDEPENDENCE
Street 19401 EAST 39 STREET
City INDEPENDENCE
State MO
ZIP 64057
Phone 816 490-4277
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/5/2025
Certificate Expiration Date 9/4/2027
Facility Type Physician Office
Lab Director STEPHANIE IKEME

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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