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

Laboratory Demographics

CLIA Number: 37D0471171

Facility Name: FGMA/FAMILY & GERIATRIC MEDICAL ASSOC

Facility Address:
5622 N PORTLAND SUITE 102
OKLAHOMA CITY, OK
ZIP 73112
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Facility Phone Number: 405 917-7590

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1922136480

Taxonomy: 363LF0000X - Nurse Practitioner

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	405 917-7590
CertificateType	3
CertificateEffectiveDate	3/4/2024
CertificateExpirationDate	3/3/2026
FacilityType	PPMP

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