26D2113473 CLIA NUMBER - HEART AND VASCULAR ASSOCIATES LLC

Laboratory Demographics

CLIA Number: 26D2113473

Facility Name: HEART AND VASCULAR ASSOCIATES LLC

Facility Address:
130 WESTMOUNT DRIVE
FARMINGTON, MO
ZIP 63640
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Facility Phone Number: 573 756-1813

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1336595198

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	26D2113473
LAB Type	Physician Office
Facility Name	HEART AND VASCULAR ASSOCIATES LLC
Street	130 WESTMOUNT DRIVE
City	FARMINGTON
State	MO
ZIP	63640
Phone	573 756-1813
CertificateType	4
CertificateEffectiveDate	5/24/2022
CertificateExpirationDate	5/23/2024
FacilityType	Waiver

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