26D2240659 CLIA NUMBER - BLAQOUT

Laboratory Demographics

CLIA Number: 26D2240659

Facility Name: BLAQOUT

Facility Address:
517 CAMPBELL ST
KANSAS CITY, MO
ZIP 64106
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Facility Phone Number: 816 866-0355

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1750072849

Taxonomy: 261QC1500X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	10/21/2023
CertificateExpirationDate	10/20/2025
FacilityType	Waiver

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