26D0940808 CLIA NUMBER - ARCHIE MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 26D0940808

Facility Name: ARCHIE MEDICAL CLINIC

Facility Address:
709 E PINE
ARCHIE, MO
ZIP 64725
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Facility Phone Number: 816 430-5777

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1760472922

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D0940808
LAB Type	Physician Office
Facility Name	ARCHIE MEDICAL CLINIC
Street	709 E PINE
City	ARCHIE
State	MO
ZIP	64725
Phone	816 430-5777
CertificateType	4
CertificateEffectiveDate	9/15/2023
CertificateExpirationDate	9/14/2025
FacilityType	Waiver

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