37D0992423 CLIA NUMBER - PARK PLACE MEDICAL, PLLC

Laboratory Demographics

  • CLIA Code: 37D0992423
  • Facility Name: PARK PLACE MEDICAL, PLLC
  • Facility Address: 500 PARK PLACE
    MUSTANG, OK
    ZIP 73064
  • Facility Phone: 405 376-5439
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DONNA R. COSBY
  • NPI Number: 1114334885
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 37D0992423
LAB Type Physician Office
Facility Name PARK PLACE MEDICAL, PLLC
Street 500 PARK PLACE
City MUSTANG
State OK
ZIP 73064
Phone 405 376-5439
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/16/2023
Certificate Expiration Date 10/15/2025
Facility Type Physician Office
Lab Director DONNA R. COSBY

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