26D0696453 CLIA NUMBER - BJC MEDICAL GROUP BARNES WEST MEDICAL CONSULTANTS

Laboratory Demographics

CLIA Number: 26D0696453

Facility Name: BJC MEDICAL GROUP BARNES WEST MEDICAL CONSULTANTS

Facility Address:
969 NORTH MASON ROAD SUITE 110
SAINT LOUIS, MO
ZIP 63141
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Facility Phone Number: 314 996-3434

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1760558829

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D0696453
LAB Type	Physician Office
Facility Name	BJC MEDICAL GROUP BARNES WEST MEDICAL CONSULTANTS
Street	969 NORTH MASON ROAD SUITE 110
City	SAINT LOUIS
State	MO
ZIP	63141
Phone	314 996-3434
CertificateType	4
CertificateEffectiveDate	9/28/2023
CertificateExpirationDate	9/27/2025
FacilityType	Waiver

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