33D1021987 CLIA NUMBER - OLEAN MEDICAL PRACTICE PLLC

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Laboratory Demographics

CLIA Number: 33D1021987

Facility Name: OLEAN MEDICAL PRACTICE PLLC

Facility Address:
14 CENTER STREET
CUBA, NY
ZIP 14727
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Facility Phone Number: 716 376-2247

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1982798781

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D1021987
LAB Type	Physician Office
Facility Name	OLEAN MEDICAL PRACTICE PLLC
Street	14 CENTER STREET
City	CUBA
State	NY
ZIP	14727
Phone	716 376-2247
CertificateType	4
CertificateEffectiveDate	2/4/2024
CertificateExpirationDate	2/3/2026
FacilityType	Waiver

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