37D1045192 CLIA NUMBER - MICKEY TYRRELL MD, PLLC

Laboratory Demographics

CLIA Number: 37D1045192

Facility Name: MICKEY TYRRELL MD, PLLC

Facility Address:
803 N FOREMAN
VINITA, OK
ZIP 74301
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Facility Phone Number: 918 256-2261

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1710925680

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	37D1045192
LAB Type	Physician Office
Facility Name	MICKEY TYRRELL MD, PLLC
Street	803 N FOREMAN
City	VINITA
State	OK
ZIP	74301
Phone	918 256-2261
CertificateType	4
CertificateEffectiveDate	9/8/2023
CertificateExpirationDate	9/7/2025
FacilityType	Waiver

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