37D2108804 CLIA NUMBER - FAMILY HEALTH AND WELLNESS SUSAN WILLARD, DO LLC

Laboratory Demographics

CLIA Number: 37D2108804

Facility Name: FAMILY HEALTH AND WELLNESS SUSAN WILLARD, DO LLC

Facility Address:
6532 E 71ST STREET, SUITE 150
TULSA, OK
ZIP 74133
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Facility Phone Number: 918 289-0091

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1013421023

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	37D2108804
LAB Type	Physician Office
Facility Name	FAMILY HEALTH AND WELLNESS SUSAN WILLARD, DO LLC
Street	6532 E 71ST STREET, SUITE 150
City	TULSA
State	OK
ZIP	74133
Phone	918 289-0091
CertificateType	4
CertificateEffectiveDate	2/12/2024
CertificateExpirationDate	2/11/2026
FacilityType	Waiver

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