26D1039724 CLIA NUMBER - PILOT GROVE MEDICAL CLINIC AT FITZGIBBON

Laboratory Demographics

  • CLIA Code: 26D1039724
  • Facility Name: PILOT GROVE MEDICAL CLINIC AT FITZGIBBON
  • Facility Address: 212 COLLEGE STREET
    PILOT GROVE, MO
    ZIP 65276
  • Facility Phone: 660 834-5100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TIM RYAN
  • NPI Number: 1669831640
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 26D1039724
LAB Type Physician Office
Facility Name PILOT GROVE MEDICAL CLINIC AT FITZGIBBON
Street 212 COLLEGE STREET
City PILOT GROVE
State MO
ZIP 65276
Phone 660 834-5100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Physician Office
Lab Director TIM RYAN

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