26D0447086 CLIA NUMBER - MERCY CLINIC-AVA

Laboratory Demographics

CLIA Number: 26D0447086

Facility Name: MERCY CLINIC-AVA

Facility Address:
1312 NORTH HIGHWAY 5 PO BOX 38
AVA, MO
ZIP 65608
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Facility Phone Number: 417 683-4045

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1770618233

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D0447086
LAB Type	Physician Office
Facility Name	MERCY CLINIC-AVA
Street	1312 NORTH HIGHWAY 5 PO BOX 38
City	AVA
State	MO
ZIP	65608
Phone	417 683-4045
CertificateType	4
CertificateEffectiveDate	8/3/2022
CertificateExpirationDate	8/2/2024
FacilityType	Waiver

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