37D1014047 CLIA NUMBER - KIAMICHI FAMILY MEDICAL CENTER

Laboratory Demographics

CLIA Number: 37D1014047

Facility Name: KIAMICHI FAMILY MEDICAL CENTER

Facility Address:
6026 BATTIEST PICKENS ROAD
BROKEN BOW, OK
ZIP 74728
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Facility Phone Number: 580 447-2910

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1134138720

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D1014047
LAB Type	Federally Qualified Health Center
Facility Name	KIAMICHI FAMILY MEDICAL CENTER
Street	6026 BATTIEST PICKENS ROAD
City	BROKEN BOW
State	OK
ZIP	74728
Phone	580 447-2910
CertificateType	4
CertificateEffectiveDate	3/27/2023
CertificateExpirationDate	3/26/2025
FacilityType	Waiver

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