37D0717676 CLIA NUMBER - JIM TALIAFERRO COMMUNITY MENTAL HEALTH CENTER

Laboratory Demographics

CLIA Number: 37D0717676

Facility Name: JIM TALIAFERRO COMMUNITY MENTAL HEALTH CENTER

Facility Address:
602 SW 38TH STREET ATTN REBECCA THORPE - FINCANCE
LAWTON, OK
ZIP 73505
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Facility Phone Number: 580 248-5780

Facility Type: Hospital

Certificate Type: Waiver

NPI Number: 1619012515

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D0717676
LAB Type	Hospital
Facility Name	JIM TALIAFERRO COMMUNITY MENTAL HEALTH CENTER
Street	602 SW 38TH STREET ATTN REBECCA THORPE - FINCANCE
City	LAWTON
State	OK
ZIP	73505
Phone	580 248-5780
CertificateType	4
CertificateEffectiveDate	8/29/2023
CertificateExpirationDate	8/28/2025
FacilityType	Waiver

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