37D2207764 CLIA NUMBER - STILLWATER MEDICAL LEGACY VILLAGE

Laboratory Demographics

  • CLIA Code: 37D2207764
  • Facility Name: STILLWATER MEDICAL LEGACY VILLAGE
  • Facility Address: 5601 N WASHINGTON
    STILLWATER, OK
    ZIP 74075
  • Facility Phone: 405 742-5753
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: MARK R. MUELLER
  • NPI Number: 1740756907
  • Taxonomy: 106H00000X - Marriage & Family Therapist

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CLIA Record

Field Name Field Value
CLIA Number 37D2207764
LAB Type Assisted Living Facility
Facility Name STILLWATER MEDICAL LEGACY VILLAGE
Street 5601 N WASHINGTON
City STILLWATER
State OK
ZIP 74075
Phone 405 742-5753
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/30/2024
Certificate Expiration Date 12/29/2026
Facility Type Assisted Living Facility
Lab Director MARK R. MUELLER

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