26D1084931 CLIA NUMBER - IRON COUNTY HOSPITAL FAMILY CARE CLINIC

Laboratory Demographics

CLIA Number: 26D1084931

Facility Name: IRON COUNTY HOSPITAL FAMILY CARE CLINIC

Facility Address:
301 N HIGHWAY 21
PILOT KNOB, MO
ZIP 63663
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Facility Phone Number: 573 546-0184

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1073799367

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D1084931
LAB Type	Physician Office
Facility Name	IRON COUNTY HOSPITAL FAMILY CARE CLINIC
Street	301 N HIGHWAY 21
City	PILOT KNOB
State	MO
ZIP	63663
Phone	573 546-0184
CertificateType	4
CertificateEffectiveDate	6/6/2022
CertificateExpirationDate	6/5/2024
FacilityType	Waiver

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