26D0442307 CLIA NUMBER - SOUTHEAST HEALTH CENTER OF STODDARD CO MALDEN

Laboratory Demographics

CLIA Number: 26D0442307

Facility Name: SOUTHEAST HEALTH CENTER OF STODDARD CO MALDEN

Facility Address:
500 N DOUGLAS ST
MALDEN, MO
ZIP 63863
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Facility Phone Number: 573 276-2221

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1316240096

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D0442307
LAB Type	Rural Health Clinic
Facility Name	SOUTHEAST HEALTH CENTER OF STODDARD CO MALDEN
Street	500 N DOUGLAS ST
City	MALDEN
State	MO
ZIP	63863
Phone	573 276-2221
CertificateType	4
CertificateEffectiveDate	8/15/2022
CertificateExpirationDate	8/14/2024
FacilityType	Waiver

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