37D2086296 CLIA NUMBER - GRAND MENTAL HEALTH

Laboratory Demographics

  • CLIA Code: 37D2086296
  • Facility Name: GRAND MENTAL HEALTH
  • Facility Address: 405 EAST EXCELSIOR
    VINITA, OK
    ZIP 74301
  • Facility Phone: 918 273-1841
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHN MALLGREN
  • NPI Number: 1265602056
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 37D2086296
LAB Type Physician Office
Facility Name GRAND MENTAL HEALTH
Street 405 EAST EXCELSIOR
City VINITA
State OK
ZIP 74301
Phone 918 273-1841
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/31/2024
Certificate Expiration Date 10/30/2026
Facility Type Physician Office
Lab Director JOHN MALLGREN

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