37D2163606 CLIA NUMBER - INTEGRIS BASS BAPTIST CENTER

Laboratory Demographics

CLIA Number: 37D2163606

Facility Name: INTEGRIS BASS BAPTIST CENTER

Facility Address:
600 S MONROE
ENID, OK
ZIP 73701
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Facility Phone Number: 580 548-1100

Facility Type: Health Fair

Certificate Type: Waiver

NPI Number: 1396216677

Taxonomy: 261QE0002X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D2163606
LAB Type	Health Fair
Facility Name	INTEGRIS BASS BAPTIST CENTER
Street	600 S MONROE
City	ENID
State	OK
ZIP	73701
Phone	580 548-1100
CertificateType	4
CertificateEffectiveDate	3/18/2023
CertificateExpirationDate	3/17/2025
FacilityType	Waiver

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