37D2070431 CLIA NUMBER - SSM HEALTH WOUND CARE, A DEPT OF SSM HEALTH ST ANTHONY HOSPITAL, SHAWNEE

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Laboratory Demographics

CLIA Number: 37D2070431

Facility Name: SSM HEALTH WOUND CARE, A DEPT OF SSM HEALTH ST ANTHONY HOSPITAL, SHAWNEE

Facility Address:
3700 N KICKAPOO ST, SUITE 132
SHAWNEE, OK
ZIP 74804
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Facility Phone Number: 405 214-1571

Facility Type: Other - WOUND CARE CLINC

Certificate Type: Waiver

NPI Number: 1689177370

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D2070431
LAB Type	Other - WOUND CARE CLINC
Facility Name	SSM HEALTH WOUND CARE, A DEPT OF SSM HEALTH ST ANTHONY HOSPITAL, SHAWNEE
Street	3700 N KICKAPOO ST, SUITE 132
City	SHAWNEE
State	OK
ZIP	74804
Phone	405 214-1571
CertificateType	4
CertificateEffectiveDate	12/16/2023
CertificateExpirationDate	12/15/2025
FacilityType	Waiver

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