37D2232710 CLIA NUMBER - PROACTIVE MD CFI WOODWARD HEALTH CENTER

Laboratory Demographics

CLIA Number: 37D2232710

Facility Name: PROACTIVE MD CFI WOODWARD HEALTH CENTER

Facility Address:
1000 TERRA DR
WOODWARD, OK
ZIP 73801
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Facility Phone Number: 580 290-1810

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1558034082

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D2232710
LAB Type	Practitioner Other
Facility Name	PROACTIVE MD CFI WOODWARD HEALTH CENTER
Street	1000 TERRA DR
City	WOODWARD
State	OK
ZIP	73801
Phone	580 290-1810
CertificateType	4
CertificateEffectiveDate	8/17/2023
CertificateExpirationDate	8/16/2025
FacilityType	Waiver

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