26D1006403 CLIA NUMBER - JEFFERSON MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 26D1006403
  • Facility Name: JEFFERSON MEDICAL GROUP
  • Facility Address: 1502 N JEFFERSON STREET
    CARROLLTON, MO
    ZIP 64633
  • Facility Phone: 660 542-1695
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RICHARD L. SMITH
  • NPI Number: 1104432806
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 26D1006403
LAB Type Physician Office
Facility Name JEFFERSON MEDICAL GROUP
Street 1502 N JEFFERSON STREET
City CARROLLTON
State MO
ZIP 64633
Phone 660 542-1695
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/15/2024
Certificate Expiration Date 11/14/2026
Facility Type Physician Office
Lab Director RICHARD L. SMITH

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