37D0471171 CLIA NUMBER - FGMA/FAMILY & GERIATRIC MEDICAL ASSOC

Laboratory Demographics

  • CLIA Code: 37D0471171
  • Facility Name: FGMA/FAMILY & GERIATRIC MEDICAL ASSOC
  • Facility Address: 5622 N PORTLAND SUITE 102
    OKLAHOMA CITY, OK
    ZIP 73112
  • Facility Phone: (405) 917-7590
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: SUSAN B. GRANDLE
  • NPI Number: 1922136480
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 37D0471171
LAB Type Physician Office
Facility Name FGMA/FAMILY & GERIATRIC MEDICAL ASSOC
Street 5622 N PORTLAND SUITE 102
City OKLAHOMA CITY
State OK
ZIP 73112
Phone 4059177590
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/4/2026
Certificate Expiration Date 3/3/2028
Facility Type Physician Office
Lab Director SUSAN B. GRANDLE

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This page was last updated on: 5/15/2026