37D1079872 CLIA NUMBER - MANGUM FAMILY CLINIC

Laboratory Demographics

CLIA Number: 37D1079872

Facility Name: MANGUM FAMILY CLINIC

Facility Address:
118 S LOUIS TITTLE
MANGUM, OK
ZIP 73554
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Facility Phone Number: 580 782-2000

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1568978708

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D1079872
LAB Type	Physician Office
Facility Name	MANGUM FAMILY CLINIC
Street	118 S LOUIS TITTLE
City	MANGUM
State	OK
ZIP	73554
Phone	580 782-2000
CertificateType	4
CertificateEffectiveDate	2/8/2024
CertificateExpirationDate	2/7/2026
FacilityType	Waiver

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