26D1075045 CLIA NUMBER - CHESTERFIELD VALLEY DERMATOLOGY, PC

Laboratory Demographics

CLIA Number: 26D1075045

Facility Name: CHESTERFIELD VALLEY DERMATOLOGY, PC

Facility Address:
100 CHESTERFIELD BUSINESS PKWY, SUITE 110
CHESTERFIELD, MO
ZIP 63005
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Facility Phone Number: 636 532-0990

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1104119916

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	26D1075045
LAB Type	Physician Office
Facility Name	CHESTERFIELD VALLEY DERMATOLOGY, PC
Street	100 CHESTERFIELD BUSINESS PKWY, SUITE 110
City	CHESTERFIELD
State	MO
ZIP	63005
Phone	636 532-0990
CertificateType	2
CertificateEffectiveDate	8/24/2022
CertificateExpirationDate	8/23/2024
FacilityType	Compliance

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