26D0437206 CLIA NUMBER - MERCY MEDICAL GROUP MERCY CLINIC INTERNAL MEDICINE

Laboratory Demographics

CLIA Number: 26D0437206

Facility Name: MERCY MEDICAL GROUP MERCY CLINIC INTERNAL MEDICINE

Facility Address:
1000 DES PERES ROAD, SUITE 310
DES PERES, MO
ZIP 63131
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Facility Phone Number: 314 821-1313

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1588939797

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D0437206
LAB Type	Physician Office
Facility Name	MERCY MEDICAL GROUP MERCY CLINIC INTERNAL MEDICINE
Street	1000 DES PERES ROAD, SUITE 310
City	DES PERES
State	MO
ZIP	63131
Phone	314 821-1313
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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