26D1073911 CLIA NUMBER - ST LOUIS SPINE & ORTHOPEDIC SURGERY CENTER

Laboratory Demographics

CLIA Number: 26D1073911

Facility Name: ST LOUIS SPINE & ORTHOPEDIC SURGERY CENTER

Facility Address:
1130 TOWN & COUNTRY COMMONS
TOWN AND COUNTRY, MO
ZIP 63017
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Facility Phone Number: 636 256-0320

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1457552846

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D1073911
LAB Type	Ambulatory Surgery Center
Facility Name	ST LOUIS SPINE & ORTHOPEDIC SURGERY CENTER
Street	1130 TOWN & COUNTRY COMMONS
City	TOWN AND COUNTRY
State	MO
ZIP	63017
Phone	636 256-0320
CertificateType	4
CertificateEffectiveDate	9/19/2023
CertificateExpirationDate	9/18/2025
FacilityType	Waiver

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