26D2152467 CLIA NUMBER - CENTERWELL SENIOR PRIMARY CARE-RAYTOWN

Laboratory Demographics

  • CLIA Code: 26D2152467
  • Facility Name: CENTERWELL SENIOR PRIMARY CARE-RAYTOWN
  • Facility Address: 9300A E GREGORY BLVD
    RAYTOWN, MO
    ZIP 64133
  • Facility Phone: 816 946-6930
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STEPHANIE IKEME
  • NPI Number: 1366922635
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 26D2152467
LAB Type Physician Office
Facility Name CENTERWELL SENIOR PRIMARY CARE-RAYTOWN
Street 9300A E GREGORY BLVD
City RAYTOWN
State MO
ZIP 64133
Phone 816 946-6930
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/9/2024
Certificate Expiration Date 8/8/2026
Facility Type Physician Office
Lab Director STEPHANIE IKEME

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