14D2136480 CLIA NUMBER - NEW LEAF PRIMARY CARE CRYSTAL STONE, LTD

Laboratory Demographics

  • CLIA Code: 14D2136480
  • Facility Name: NEW LEAF PRIMARY CARE CRYSTAL STONE, LTD
  • Facility Address: 423 N HIGH ST
    BELLEVILLE, IL
    ZIP 62220
  • Facility Phone: 618 416-7738
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: CRYSTAL L. STONE
  • NPI Number: 1619409075
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2136480
LAB Type Practitioner Other
Facility Name NEW LEAF PRIMARY CARE CRYSTAL STONE, LTD
Street 423 N HIGH ST
City BELLEVILLE
State IL
ZIP 62220
Phone 618 416-7738
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/11/2025
Certificate Expiration Date 9/10/2027
Facility Type Practitioner Other
Lab Director CRYSTAL L. STONE

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