37D2161164 CLIA NUMBER - GRACE DPC

Laboratory Demographics

  • CLIA Code: 37D2161164
  • Facility Name: GRACE DPC
  • Facility Address: 221 S GRAND AVE
    CHEROKEE, OK
    ZIP 73728
  • Facility Phone: 580 307-6263
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NIKI LEWIS-WYATT
  • NPI Number: 1477025658
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 37D2161164
LAB Type Physician Office
Facility Name GRACE DPC
Street 221 S GRAND AVE
City CHEROKEE
State OK
ZIP 73728
Phone 580 307-6263
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/28/2025
Certificate Expiration Date 1/27/2027
Facility Type Physician Office
Lab Director NIKI LEWIS-WYATT

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