37D2141909 CLIA NUMBER - BLACK OAK CLINIC LLC

Laboratory Demographics

  • CLIA Code: 37D2141909
  • Facility Name: BLACK OAK CLINIC LLC
  • Facility Address: 110 W 1ST STREET
    BROKEN BOW, OK
    ZIP 74728
  • Facility Phone: 580 584-3099
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MEGAN E. BLACK
  • NPI Number: 1366954661
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 37D2141909
LAB Type Practitioner Other
Facility Name BLACK OAK CLINIC LLC
Street 110 W 1ST STREET
City BROKEN BOW
State OK
ZIP 74728
Phone 580 584-3099
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/27/2023
Certificate Expiration Date 12/26/2025
Facility Type Practitioner Other
Lab Director MEGAN E. BLACK

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