37D2191104 CLIA NUMBER - REVAN HEALTH

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Laboratory Demographics

CLIA Number: 37D2191104

Facility Name: REVAN HEALTH

Facility Address:
5601 NW 72ND ST, STE 142
WARR ACRES, OK
ZIP 73132
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Facility Phone Number: 405 896-7975

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1114540689

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	37D2191104
LAB Type	Practitioner Other
Facility Name	REVAN HEALTH
Street	5601 NW 72ND ST, STE 142
City	WARR ACRES
State	OK
ZIP	73132
Phone	405 896-7975
CertificateType	4
CertificateEffectiveDate	8/24/2022
CertificateExpirationDate	8/23/2024
FacilityType	Waiver

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