26D0440044 CLIA NUMBER - EPIPHANY DERMATOLOGY OF MISSOURI, LLC

Laboratory Demographics

  • CLIA Code: 26D0440044
  • Facility Name: EPIPHANY DERMATOLOGY OF MISSOURI, LLC
  • Facility Address: 3009 N BALLAS RD STE 310-A
    SAINT LOUIS, MO
    ZIP 63131
  • Facility Phone: 314 993-2909
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: LEE S. PORTNOFF
  • NPI Number: 1043214505
  • Taxonomy: 207ND0101X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 26D0440044
LAB Type Physician Office
Facility Name EPIPHANY DERMATOLOGY OF MISSOURI, LLC
Street 3009 N BALLAS RD STE 310-A
City SAINT LOUIS
State MO
ZIP 63131
Phone 314 993-2909
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 12/2/2024
Certificate Expiration Date 12/1/2026
Facility Type Physician Office
Lab Director LEE S. PORTNOFF

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