26D1055859 CLIA NUMBER - DIABETES CENTER CENTER FOR ADVANCED MEDICINE

Laboratory Demographics

CLIA Number: 26D1055859

Facility Name: DIABETES CENTER CENTER FOR ADVANCED MEDICINE

Facility Address:
4921 PARKVIEW PLACE, 13TH FLOOR, STE B CENTER FOR ADV MEDICINE
SAINT LOUIS, MO
ZIP 63110
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Facility Phone Number: 314 286-2625

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1942933296

Taxonomy: 261QC1500X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D1055859
LAB Type	Physician Office
Facility Name	DIABETES CENTER CENTER FOR ADVANCED MEDICINE
Street	4921 PARKVIEW PLACE, 13TH FLOOR, STE B CENTER FOR ADV MEDICINE
City	SAINT LOUIS
State	MO
ZIP	63110
Phone	314 286-2625
CertificateType	4
CertificateEffectiveDate	6/28/2022
CertificateExpirationDate	6/27/2024
FacilityType	Waiver

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