37D2094002 CLIA NUMBER - PREMIER PEDIATRIC AND ADOLESCENT CARE

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Laboratory Demographics

CLIA Number: 37D2094002

Facility Name: PREMIER PEDIATRIC AND ADOLESCENT CARE

Facility Address:
2009 N MAIN ST
MUSKOGEE, OK
ZIP 74401
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Facility Phone Number: 918 816-4024

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1730560699

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	37D2094002
LAB Type	Physician Office
Facility Name	PREMIER PEDIATRIC AND ADOLESCENT CARE
Street	2009 N MAIN ST
City	MUSKOGEE
State	OK
ZIP	74401
Phone	918 816-4024
CertificateType	4
CertificateEffectiveDate	11/29/2022
CertificateExpirationDate	11/28/2024
FacilityType	Waiver

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