37D2235200 CLIA NUMBER - GIDEON FAMILY CARE

Laboratory Demographics

CLIA Number: 37D2235200

Facility Name: GIDEON FAMILY CARE

Facility Address:
1601 SW 89TH ST, STE D200
OKLAHOMA CITY, OK
ZIP 73159
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Facility Phone Number: 405 708-4498

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1487227617

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D2235200
LAB Type	Practitioner Other
Facility Name	GIDEON FAMILY CARE
Street	1601 SW 89TH ST, STE D200
City	OKLAHOMA CITY
State	OK
ZIP	73159
Phone	405 708-4498
CertificateType	4
CertificateEffectiveDate	9/7/2023
CertificateExpirationDate	9/6/2025
FacilityType	Waiver

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