37D2168471 CLIA NUMBER - PREMISE HEALTH OF OKLAHOMA MEDICAL PC

Laboratory Demographics

CLIA Number: 37D2168471

Facility Name: PREMISE HEALTH OF OKLAHOMA MEDICAL PC

Facility Address:
915 E GARRIOTT DRIVE, STE E
ENID, OK
ZIP 73701
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Facility Phone Number: 580 701-2582

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1568021459

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D2168471
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF OKLAHOMA MEDICAL PC
Street	915 E GARRIOTT DRIVE, STE E
City	ENID
State	OK
ZIP	73701
Phone	580 701-2582
CertificateType	4
CertificateEffectiveDate	7/1/2023
CertificateExpirationDate	6/30/2025
FacilityType	Waiver

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