39D2023096 CLIA NUMBER - FRANK OLNEY & RUDY NICOLAS, PTRS DBA 611 MRI-CT

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Laboratory Demographics

CLIA Number: 39D2023096

Facility Name: FRANK OLNEY & RUDY NICOLAS, PTRS DBA 611 MRI-CT

Facility Address:
2950 FAIRWAY DRIVE
ALTOONA, PA
ZIP 16602
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Facility Phone Number: 814 946-8000

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1417918756

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	39D2023096
LAB Type	Physician Office
Facility Name	FRANK OLNEY & RUDY NICOLAS, PTRS DBA 611 MRI-CT
Street	2950 FAIRWAY DRIVE
City	ALTOONA
State	PA
ZIP	16602
Phone	814 946-8000
CertificateType	4
CertificateEffectiveDate	4/15/2023
CertificateExpirationDate	4/14/2025
FacilityType	Waiver

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