26D2240659 CLIA NUMBER - BLAQOUT

Laboratory Demographics

  • CLIA Code: 26D2240659
  • Facility Name: BLAQOUT
  • Facility Address: 517 CAMPBELL ST
    KANSAS CITY, MO
    ZIP 64106
  • Facility Phone: 816 866-0355
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: ANUBHAV KIDAMBI
  • NPI Number: 1750072849
  • Taxonomy: 261QC1500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 26D2240659
LAB Type Community Clinic
Facility Name BLAQOUT
Street 517 CAMPBELL ST
City KANSAS CITY
State MO
ZIP 64106
Phone 816 866-0355
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/21/2025
Certificate Expiration Date 10/20/2027
Facility Type Community Clinic
Lab Director ANUBHAV KIDAMBI

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