37D2149537 CLIA NUMBER - KIAMICHI FAMILY MEDICAL CENTER, INC

Laboratory Demographics

CLIA Number: 37D2149537

Facility Name: KIAMICHI FAMILY MEDICAL CENTER, INC

Facility Address:
510 S PARK DRIVE
BROKEN BOW, OK
ZIP 74728
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Facility Phone Number: 580 241-5294

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1902269012

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D2149537
LAB Type	Federally Qualified Health Center
Facility Name	KIAMICHI FAMILY MEDICAL CENTER, INC
Street	510 S PARK DRIVE
City	BROKEN BOW
State	OK
ZIP	74728
Phone	580 241-5294
CertificateType	4
CertificateEffectiveDate	6/5/2022
CertificateExpirationDate	6/4/2024
FacilityType	Waiver

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