26D1088729 CLIA NUMBER - PREMIER MEDICAL PHYSICIANS LLC

Laboratory Demographics

CLIA Code: 26D1088729
Facility Name: PREMIER MEDICAL PHYSICIANS LLC
Facility Address: 2325 DOUGHERTY FERRY ROAD, SUITE 104
SAINT LOUIS, MO
ZIP 63122
Facility Phone: 314 821-6889
Facility Type: Physician Office
Facility Type: Microscopy
Lab Director: VINCENT P. FORTUNATO
NPI Number: 1417459207
Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name	Field Value
CLIA Number	26D1088729
LAB Type	Physician Office
Facility Name	PREMIER MEDICAL PHYSICIANS LLC
Street	2325 DOUGHERTY FERRY ROAD, SUITE 104
City	SAINT LOUIS
State	MO
ZIP	63122
Phone	314 821-6889
Certificate Type	Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description	This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date	6/25/2025
Certificate Expiration Date	6/24/2027
Facility Type	Physician Office
Lab Director	VINCENT P. FORTUNATO

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