37D1067992 CLIA NUMBER - CROUCH FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 37D1067992

Facility Name: CROUCH FAMILY MEDICINE

Facility Address:
806 MANVEL AVE
CHANDLER, OK
ZIP 74834
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Facility Phone Number: 405 258-9955

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1609093228

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D1067992
LAB Type	Physician Office
Facility Name	CROUCH FAMILY MEDICINE
Street	806 MANVEL AVE
City	CHANDLER
State	OK
ZIP	74834
Phone	405 258-9955
CertificateType	4
CertificateEffectiveDate	4/30/2023
CertificateExpirationDate	4/29/2025
FacilityType	Waiver

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