26D0996443 CLIA NUMBER - MCPHERSON MEDICAL AND DIAGNOSTICS DBA AMMO DBA SCOTT CITY MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 26D0996443

Facility Name: MCPHERSON MEDICAL AND DIAGNOSTICS DBA AMMO DBA SCOTT CITY MEDICAL CLINIC

Facility Address:
2102 MAIN STREET
SCOTT CITY, MO
ZIP 63780
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Facility Phone Number: 573 264-0042

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1902924038

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D0996443
LAB Type	Physician Office
Facility Name	MCPHERSON MEDICAL AND DIAGNOSTICS DBA AMMO DBA SCOTT CITY MEDICAL CLINIC
Street	2102 MAIN STREET
City	SCOTT CITY
State	MO
ZIP	63780
Phone	573 264-0042
CertificateType	4
CertificateEffectiveDate	2/19/2024
CertificateExpirationDate	2/18/2026
FacilityType	Waiver

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