26D1057142 CLIA NUMBER - SOUTHEAST HEALTH-POPLAR BLUFF

Laboratory Demographics

CLIA Code: 26D1057142
Facility Name: SOUTHEAST HEALTH-POPLAR BLUFF
Facility Address: 2002 KANELL BLVD 105
POPLAR BLUFF, MO
ZIP 63901
Facility Phone: 573 712-2309
Facility Type: Ancillary Testing Site in Health Care Center
Facility Type: Waiver
Lab Director: LAUREN E. THOMAS
NPI Number: 1568601482
Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	26D1057142
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	SOUTHEAST HEALTH-POPLAR BLUFF
Street	2002 KANELL BLVD 105
City	POPLAR BLUFF
State	MO
ZIP	63901
Phone	573 712-2309
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	8/1/2024
Certificate Expiration Date	7/31/2026
Facility Type	Ancillary Testing Site in Health Care Center
Lab Director	LAUREN E. THOMAS

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