26D0992315 CLIA NUMBER - SOUTHEAST CORRECTIONAL CENTER

Laboratory Demographics

CLIA Number: 26D0992315

Facility Name: SOUTHEAST CORRECTIONAL CENTER

Facility Address:
300 PEDRO SIMMONS DRIVE
CHARLESTON, MO
ZIP 63834
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Facility Phone Number: 573 683-4409

Facility Type: Prison

Certificate Type: Certificate of Compliance

NPI Number: 1841289402

Taxonomy: 208800000X - Urology
A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

CLIA Record

Field Name	Field Value
CLIA Number	26D0992315
LAB Type	Prison
Facility Name	SOUTHEAST CORRECTIONAL CENTER
Street	300 PEDRO SIMMONS DRIVE
City	CHARLESTON
State	MO
ZIP	63834
Phone	573 683-4409
CertificateType	2
CertificateEffectiveDate	1/30/2023
CertificateExpirationDate	1/29/2025
FacilityType	Compliance

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