37D2199052 CLIA NUMBER - VAO SERVICE PROVIDER, LLC

Laboratory Demographics

  • CLIA Code: 37D2199052
  • Facility Name: VAO SERVICE PROVIDER, LLC
  • Facility Address: 817 S W 59TH STREET
    OKLAHOMA CITY, OK
    ZIP 73109
  • Facility Phone: (405) 605-6353
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: GARY L. SHAVERS
  • NPI Number: 1316253008
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 37D2199052
LAB Type Assisted Living Facility
Facility Name VAO SERVICE PROVIDER, LLC
Street 817 S W 59TH STREET
City OKLAHOMA CITY
State OK
ZIP 73109
Phone 4056056353
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/5/2024
Certificate Expiration Date 11/4/2026
Facility Type Assisted Living Facility
Lab Director GARY L. SHAVERS

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This page was last updated on: 5/18/2026