26D2043709 CLIA NUMBER - REVITALIFE WELLNESS CENTER, LLC

Laboratory Demographics

  • CLIA Code: 26D2043709
  • Facility Name: REVITALIFE WELLNESS CENTER, LLC
  • Facility Address: 13354 MANCHESTER ROAD, SUITE 100
    ST. LOUIS, MO
    ZIP 63131
  • Facility Phone: 314 475-3126
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHRISTINA A. SOWERS
  • NPI Number: 1104185685
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 26D2043709
LAB Type Physician Office
Facility Name REVITALIFE WELLNESS CENTER, LLC
Street 13354 MANCHESTER ROAD, SUITE 100
City ST. LOUIS
State MO
ZIP 63131
Phone 314 475-3126
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/9/2024
Certificate Expiration Date 7/8/2026
Facility Type Physician Office
Lab Director CHRISTINA A. SOWERS

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