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26D1054541 CLIA NUMBER - MERCY CLINIC PRIMARY CARE - SOUTHFORK SUITE 220

Laboratory Demographics

CLIA Number: 26D1054541

Facility Name: MERCY CLINIC PRIMARY CARE - SOUTHFORK SUITE 220

Facility Address:
12700 SOUTHFORK ROAD SUITE 220
SAINT LOUIS, MO
ZIP 63128
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Facility Phone Number: 314 543-5984

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1326235375

Taxonomy: 207R00000X - Internal Medicine
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

CLIA Record

Field Name Field Value
CLIA Number 26D1054541
LAB Type Physician Office
Facility Name MERCY CLINIC PRIMARY CARE - SOUTHFORK SUITE 220
Street 12700 SOUTHFORK ROAD SUITE 220
City SAINT LOUIS
State MO
ZIP 63128
Phone 314 543-5984
CertificateType 4
CertificateEffectiveDate 5/24/2022
CertificateExpirationDate 5/23/2024
FacilityType Waiver

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