37D0475572 CLIA NUMBER - ROBERT CLARK FAMILY HEALTH CENTER FAIRFAX MEDICAL FACILITIES, INC

Laboratory Demographics

CLIA Number: 37D0475572

Facility Name: ROBERT CLARK FAMILY HEALTH CENTER FAIRFAX MEDICAL FACILITIES, INC

Facility Address:
212 NORTH MAIN STREET
FAIRFAX, OK
ZIP 74637
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Facility Phone Number: 918 642-3100

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1538183173

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D0475572
LAB Type	Federally Qualified Health Center
Facility Name	ROBERT CLARK FAMILY HEALTH CENTER FAIRFAX MEDICAL FACILITIES, INC
Street	212 NORTH MAIN STREET
City	FAIRFAX
State	OK
ZIP	74637
Phone	918 642-3100
CertificateType	3
CertificateEffectiveDate	7/5/2023
CertificateExpirationDate	7/4/2025
FacilityType	PPMP

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