37D2297364 CLIA NUMBER - MEDACY HEALTH PRIMARY CARE KAIMO ENTERPRISES, LLC

Laboratory Demographics

  • CLIA Code: 37D2297364
  • Facility Name: MEDACY HEALTH PRIMARY CARE KAIMO ENTERPRISES, LLC
  • Facility Address: 2328 N INTERSTATE DR
    NORMAN, OK
    ZIP 73072
  • Facility Phone: 405 857-2179
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: RYAN D. WILSON
  • NPI Number: 1215704192
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 37D2297364
LAB Type Practitioner Other
Facility Name MEDACY HEALTH PRIMARY CARE KAIMO ENTERPRISES, LLC
Street 2328 N INTERSTATE DR
City NORMAN
State OK
ZIP 73072
Phone 405 857-2179
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/16/2024
Certificate Expiration Date 1/15/2026
Facility Type Practitioner Other
Lab Director RYAN D. WILSON

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