26D0690681 CLIA NUMBER - PIKE MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 26D0690681

Facility Name: PIKE MEDICAL CLINIC

Facility Address:
211 SOUTH THIRD STREET
LOUISIANA, MO
ZIP 63353
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Facility Phone Number: 573 754-5555

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1558389189

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D0690681
LAB Type	Physician Office
Facility Name	PIKE MEDICAL CLINIC
Street	211 SOUTH THIRD STREET
City	LOUISIANA
State	MO
ZIP	63353
Phone	573 754-5555
CertificateType	2
CertificateEffectiveDate	9/22/2022
CertificateExpirationDate	9/21/2024
FacilityType	Compliance

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