26D2122443 CLIA NUMBER - SUSAN D PURCELL MD DERMATOLOGY LLC DBA PURCELL DERMATOLOGY

Laboratory Demographics

CLIA Number: 26D2122443

Facility Name: SUSAN D PURCELL MD DERMATOLOGY LLC DBA PURCELL DERMATOLOGY

Facility Address:
969 N MASON RD SUITE 170
SAINT LOUIS, MO
ZIP 63141
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Facility Phone Number: 314 985-8000

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1871044735

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	26D2122443
LAB Type	Physician Office
Facility Name	SUSAN D PURCELL MD DERMATOLOGY LLC DBA PURCELL DERMATOLOGY
Street	969 N MASON RD SUITE 170
City	SAINT LOUIS
State	MO
ZIP	63141
Phone	314 985-8000
CertificateType	4
CertificateEffectiveDate	9/17/2022
CertificateExpirationDate	9/16/2024
FacilityType	Waiver

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