26D2119419 CLIA NUMBER - MISSOURI OCCUPATIONAL MEDICINE

Laboratory Demographics

  • CLIA Code: 26D2119419
  • Facility Name: MISSOURI OCCUPATIONAL MEDICINE
  • Facility Address: 851 E 5TH ST STE152
    WASHINGTON, MO
    ZIP 63090
  • Facility Phone: 636 239-0735
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BOBBY V. ENVETCHAKUL
  • NPI Number: 1720040165
  • Taxonomy: 207L00000X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 26D2119419
LAB Type Physician Office
Facility Name MISSOURI OCCUPATIONAL MEDICINE
Street 851 E 5TH ST STE152
City WASHINGTON
State MO
ZIP 63090
Phone 636 239-0735
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/27/2024
Certificate Expiration Date 9/26/2026
Facility Type Physician Office
Lab Director BOBBY V. ENVETCHAKUL

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