26D2100913 CLIA NUMBER - MERCY CLINIC INTERNAL MEDICINE - SOUTHFORK

Laboratory Demographics

  • CLIA Code: 26D2100913
  • Facility Name: MERCY CLINIC INTERNAL MEDICINE - SOUTHFORK
  • Facility Address: 12700 SOUTHFORK ROAD STE 200
    SAINT LOUIS, MO
    ZIP 63128
  • Facility Phone: 314 543-5942
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUSAN W. YANG
  • NPI Number: 1497088082
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 26D2100913
LAB Type Physician Office
Facility Name MERCY CLINIC INTERNAL MEDICINE - SOUTHFORK
Street 12700 SOUTHFORK ROAD STE 200
City SAINT LOUIS
State MO
ZIP 63128
Phone 314 543-5942
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2024
Certificate Expiration Date 9/30/2026
Facility Type Physician Office
Lab Director SUSAN W. YANG

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