26D0440988 CLIA NUMBER - BOONSLICK MEDICAL GROUP, INC

Laboratory Demographics

CLIA Number: 26D0440988

Facility Name: BOONSLICK MEDICAL GROUP, INC

Facility Address:
201 BJC ST PETERS DRIVE, SUITE 100
SAINT PETERS, MO
ZIP 63376
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Facility Phone Number: 636 916-8228

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1972666162

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	26D0440988
LAB Type	Physician Office
Facility Name	BOONSLICK MEDICAL GROUP, INC
Street	201 BJC ST PETERS DRIVE, SUITE 100
City	SAINT PETERS
State	MO
ZIP	63376
Phone	636 916-8228
CertificateType	3
CertificateEffectiveDate	12/22/2023
CertificateExpirationDate	12/21/2025
FacilityType	PPMP

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