21D2306455 CLIA NUMBER - MERCY HEALTH CARE AND CLINIC

Laboratory Demographics

  • CLIA Code: 21D2306455
  • Facility Name: MERCY HEALTH CARE AND CLINIC
  • Facility Address: 1400 MERCANTILE LANE SUITE 204
    LARGO, MD
    ZIP 20774
  • Facility Phone: 137 610-5882
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: CHINYENUM OTUYA
  • NPI Number: 1780915868
  • Taxonomy: 372500000X - Chore Provider

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CLIA Record

Field Name Field Value
CLIA Number 21D2306455
LAB Type Ancillary Testing Site in Health Care Center
Facility Name MERCY HEALTH CARE AND CLINIC
Street 1400 MERCANTILE LANE SUITE 204
City LARGO
State MD
ZIP 20774
Phone 137 610-5882
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/18/2024
Certificate Expiration Date 6/17/2026
Facility Type Ancillary Testing Site in Health Care Center
Lab Director CHINYENUM OTUYA

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