37D2089428 CLIA NUMBER - WAGONER FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 37D2089428
  • Facility Name: WAGONER FAMILY PRACTICE
  • Facility Address: 1202 WEST CHEROKEE, STE E ATTN KATIE SAMPSON
    WAGONER, OK
    ZIP 74467
  • Facility Phone: 918 485-1877
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID GOOD
  • NPI Number: 1821276817
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 37D2089428
LAB Type Physician Office
Facility Name WAGONER FAMILY PRACTICE
Street 1202 WEST CHEROKEE, STE E ATTN KATIE SAMPSON
City WAGONER
State OK
ZIP 74467
Phone 918 485-1877
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/30/2024
Certificate Expiration Date 12/29/2026
Facility Type Physician Office
Lab Director DAVID GOOD

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