26D2006703 CLIA NUMBER - LAKE ST LOUIS AT HOME

Laboratory Demographics

  • CLIA Code: 26D2006703
  • Facility Name: LAKE ST LOUIS AT HOME
  • Facility Address: 200 BREVCO PLAZA, STE 202
    LAKE SAINT LOUIS, MO
    ZIP 63367
  • Facility Phone: 636 625-4460
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DYK PIORT
  • NPI Number: 1396074597
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 26D2006703
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LAKE ST LOUIS AT HOME
Street 200 BREVCO PLAZA, STE 202
City LAKE SAINT LOUIS
State MO
ZIP 63367
Phone 636 625-4460
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2024
Certificate Expiration Date 4/27/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DYK PIORT

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