26D2027831 CLIA NUMBER - MERCY CLINIC OB/GYN - 714 GRAVOIS ROAD

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Laboratory Demographics

CLIA Number: 26D2027831

Facility Name: MERCY CLINIC OB/GYN - 714 GRAVOIS ROAD

Facility Address:
714 GRAVOIS ROAD, SUITE 115
FENTON, MO
ZIP 63026
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Facility Phone Number: 636 717-6775

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1144623786

Taxonomy: 207V00000X - Obstetrics & Gynecology
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

CLIA Record

Field Name	Field Value
CLIA Number	26D2027831
LAB Type	Physician Office
Facility Name	MERCY CLINIC OB/GYN - 714 GRAVOIS ROAD
Street	714 GRAVOIS ROAD, SUITE 115
City	FENTON
State	MO
ZIP	63026
Phone	636 717-6775
CertificateType	4
CertificateEffectiveDate	3/13/2023
CertificateExpirationDate	3/12/2025
FacilityType	Waiver

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