26D1000864 CLIA NUMBER - MISSOURI DELTA DERMATOLOGY

Laboratory Demographics

CLIA Number: 26D1000864

Facility Name: MISSOURI DELTA DERMATOLOGY

Facility Address:
1015 N MAIN STREET
SIKESTON, MO
ZIP 63801
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Facility Phone Number: 573 472-7777

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1972944593

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D1000864
LAB Type	Physician Office
Facility Name	MISSOURI DELTA DERMATOLOGY
Street	1015 N MAIN STREET
City	SIKESTON
State	MO
ZIP	63801
Phone	573 472-7777
CertificateType	3
CertificateEffectiveDate	2/1/2024
CertificateExpirationDate	1/31/2026
FacilityType	PPMP

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