26D2132956 CLIA NUMBER - CITIZENS MEMORIAL BROADWAY LAB

Laboratory Demographics

CLIA Number: 26D2132956

Facility Name: CITIZENS MEMORIAL BROADWAY LAB

Facility Address:
2001 W BROADWAY
BOLIVAR, MO
ZIP 65613
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Facility Phone Number: 417 328-7620

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Accreditation

NPI Number: 1568737161

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	26D2132956
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	CITIZENS MEMORIAL BROADWAY LAB
Street	2001 W BROADWAY
City	BOLIVAR
State	MO
ZIP	65613
Phone	417 328-7620
CertificateType	1
CertificateEffectiveDate	11/1/2023
CertificateExpirationDate	10/31/2025
FacilityType	Accreditation

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