37D2323616 CLIA NUMBER - PONCA CITY FAMILY HEALTH FAIRFAX MEDICAL FACILITIES, INC

Laboratory Demographics

  • CLIA Code: 37D2323616
  • Facility Name: PONCA CITY FAMILY HEALTH FAIRFAX MEDICAL FACILITIES, INC
  • Facility Address: 122 E GRAND AVE
    PONCA CITY, OK
    ZIP 74601
  • Facility Phone: 918 642-3100
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: NEAL BROCKBANK
  • NPI Number: 1740837889
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 37D2323616
LAB Type Federally Qualified Health Center
Facility Name PONCA CITY FAMILY HEALTH FAIRFAX MEDICAL FACILITIES, INC
Street 122 E GRAND AVE
City PONCA CITY
State OK
ZIP 74601
Phone 918 642-3100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/9/2025
Certificate Expiration Date 5/8/2027
Facility Type Federally Qualified Health Center
Lab Director NEAL BROCKBANK

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