26D0946699 CLIA NUMBER - MID COUNTY DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 26D0946699
  • Facility Name: MID COUNTY DERMATOLOGY
  • Facility Address: 3009 N BALLAS ROAD BLDG B SUITE 208
    SAINT LOUIS, MO
    ZIP 63131
  • Facility Phone: 314 994-0200
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CONNIE F. GIBSTINE
  • NPI Number: 1295913028
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 26D0946699
LAB Type Physician Office
Facility Name MID COUNTY DERMATOLOGY
Street 3009 N BALLAS ROAD BLDG B SUITE 208
City SAINT LOUIS
State MO
ZIP 63131
Phone 314 994-0200
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/1/2024
Certificate Expiration Date 5/31/2026
Facility Type Physician Office
Lab Director CONNIE F. GIBSTINE

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This page was last updated on: 9/29/2025