26D0906532 CLIA NUMBER - FITZGIBBON FAMILY HEALTH

Laboratory Demographics

CLIA Number: 26D0906532

Facility Name: FITZGIBBON FAMILY HEALTH

Facility Address:
600 W MORRISON ST
FAYETTE, MO
ZIP 65248
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Facility Phone Number: 660 248-2900

Facility Type: Rural Health Clinic

Certificate Type: Microscopy

NPI Number: 1316140494

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D0906532
LAB Type	Rural Health Clinic
Facility Name	FITZGIBBON FAMILY HEALTH
Street	600 W MORRISON ST
City	FAYETTE
State	MO
ZIP	65248
Phone	660 248-2900
CertificateType	3
CertificateEffectiveDate	10/2/2023
CertificateExpirationDate	10/1/2025
FacilityType	PPMP

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