37D2048295 CLIA NUMBER - COMPREHENSIVE DIAGNOSTIC IMAGING

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Laboratory Demographics

CLIA Number: 37D2048295

Facility Name: COMPREHENSIVE DIAGNOSTIC IMAGING

Facility Address:
5800 NORTH PORTLAND AVE
OKLAHOMA CITY, OK
ZIP 73112
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Facility Phone Number: 405 601-4500

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1962768143

Taxonomy: 261QR0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D2048295
LAB Type	Physician Office
Facility Name	COMPREHENSIVE DIAGNOSTIC IMAGING
Street	5800 NORTH PORTLAND AVE
City	OKLAHOMA CITY
State	OK
ZIP	73112
Phone	405 601-4500
CertificateType	4
CertificateEffectiveDate	10/12/2022
CertificateExpirationDate	10/11/2024
FacilityType	Waiver

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