26D2111637 CLIA NUMBER - PREMISE HEALTH OF MISSOURI MEDICAL, PC

Laboratory Demographics

CLIA Number: 26D2111637

Facility Name: PREMISE HEALTH OF MISSOURI MEDICAL, PC

Facility Address:
600 NW MURRAY RD SUITE 103
LEES SUMMIT, MO
ZIP 64081
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Facility Phone Number: 816 744-8019

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1912670860

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D2111637
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF MISSOURI MEDICAL, PC
Street	600 NW MURRAY RD SUITE 103
City	LEES SUMMIT
State	MO
ZIP	64081
Phone	816 744-8019
CertificateType	4
CertificateEffectiveDate	4/12/2024
CertificateExpirationDate	4/11/2026
FacilityType	Waiver

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