26D0952700 CLIA NUMBER - INTERNAL MEDICINE AT WINGHAVEN

Laboratory Demographics

  • CLIA Code: 26D0952700
  • Facility Name: INTERNAL MEDICINE AT WINGHAVEN
  • Facility Address: 5551 WING HAVEN BLVD STE 290
    O FALLON, MO
    ZIP 63368
  • Facility Phone: 636 695-2575
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GARY D. GRAY
  • NPI Number: 1033350541
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 26D0952700
LAB Type Physician Office
Facility Name INTERNAL MEDICINE AT WINGHAVEN
Street 5551 WING HAVEN BLVD STE 290
City O FALLON
State MO
ZIP 63368
Phone 636 695-2575
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/19/2024
Certificate Expiration Date 10/18/2026
Facility Type Physician Office
Lab Director GARY D. GRAY

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