37D2038712 CLIA NUMBER - OUCP ADOLESCENT MEDICINE CLINIC

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Laboratory Demographics

CLIA Number: 37D2038712

Facility Name: OUCP ADOLESCENT MEDICINE CLINIC

Facility Address:
1200 CHILDREN'S AVENUE, SUITE 5F
OKLAHOMA CITY, OK
ZIP 73104
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Facility Phone Number: 405 271-6208

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1376984955

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D2038712
LAB Type	Physician Office
Facility Name	OUCP ADOLESCENT MEDICINE CLINIC
Street	1200 CHILDREN'S AVENUE, SUITE 5F
City	OKLAHOMA CITY
State	OK
ZIP	73104
Phone	405 271-6208
CertificateType	4
CertificateEffectiveDate	9/18/2023
CertificateExpirationDate	9/17/2025
FacilityType	Waiver

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