37D2058894 CLIA NUMBER - BROKEN ARROW DIAGNOSTIC MEDICINE

Laboratory Demographics

  • CLIA Code: 37D2058894
  • Facility Name: BROKEN ARROW DIAGNOSTIC MEDICINE
  • Facility Address: 5050 E KENOSHA ST
    BROKEN ARROW, OK
    ZIP 74014
  • Facility Phone: 918 994-5140
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JACOB L. CALLISON
  • NPI Number: 1801913371
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 37D2058894
LAB Type Physician Office
Facility Name BROKEN ARROW DIAGNOSTIC MEDICINE
Street 5050 E KENOSHA ST
City BROKEN ARROW
State OK
ZIP 74014
Phone 918 994-5140
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2025
Certificate Expiration Date 5/13/2027
Facility Type Physician Office
Lab Director JACOB L. CALLISON

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This page was last updated on: 9/29/2025