37D0975976 CLIA NUMBER - INTER TRIBAL COUNCIL INC WIC PROGRAM

Laboratory Demographics

  • CLIA Code: 37D0975976
  • Facility Name: INTER TRIBAL COUNCIL INC WIC PROGRAM
  • Facility Address: 21 N EIGHT TRIBES TRAIL, STE C
    MIAMI, OK
    ZIP 74354
  • Facility Phone: 918 918-4050
  • Facility Type: Other - WIC PROGRAM
  • Facility Type: Waiver
  • Lab Director: MICHALE R. LASITER
  • NPI Number: 1942414974
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 37D0975976
LAB Type Other - WIC PROGRAM
Facility Name INTER TRIBAL COUNCIL INC WIC PROGRAM
Street 21 N EIGHT TRIBES TRAIL, STE C
City MIAMI
State OK
ZIP 74354
Phone 918 918-4050
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/21/2024
Certificate Expiration Date 7/20/2026
Facility Type Other - WIC PROGRAM
Lab Director MICHALE R. LASITER

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This page was last updated on: 9/29/2025