53D2121114 CLIA NUMBER - KIMBALL COUNTY HOSPITAL DBA PINE BLUFFS KHS HEALTH CLINIC

Laboratory Demographics

CLIA Number: 53D2121114

Facility Name: KIMBALL COUNTY HOSPITAL DBA PINE BLUFFS KHS HEALTH CLINIC

Facility Address:
117 EAST 4TH STREET
PINE BLUFFS, WY
ZIP 82082
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Facility Phone Number: 308 235-1951

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1255761631

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	53D2121114
LAB Type	Rural Health Clinic
Facility Name	KIMBALL COUNTY HOSPITAL DBA PINE BLUFFS KHS HEALTH CLINIC
Street	117 EAST 4TH STREET
City	PINE BLUFFS
State	WY
ZIP	82082
Phone	308 235-1951
CertificateType	4
CertificateEffectiveDate	10/31/2022
CertificateExpirationDate	10/30/2024
FacilityType	Waiver

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