37D2231833 CLIA NUMBER - PREMISE HEALTH OF OKLAHOMA MEDICAL, PC

Laboratory Demographics

CLIA Number: 37D2231833

Facility Name: PREMISE HEALTH OF OKLAHOMA MEDICAL, PC

Facility Address:
101 N ROBINSON AVE, STE 200
OKLAHOMA CITY, OK
ZIP 73102
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Facility Phone Number: 405 552-6110

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1902475957

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D2231833
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF OKLAHOMA MEDICAL, PC
Street	101 N ROBINSON AVE, STE 200
City	OKLAHOMA CITY
State	OK
ZIP	73102
Phone	405 552-6110
CertificateType	4
CertificateEffectiveDate	8/6/2023
CertificateExpirationDate	8/5/2025
FacilityType	Waiver

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