26D2171968 CLIA NUMBER - GATEWAY DIRECT PRIMARY CARE JV LLC

Laboratory Demographics

  • CLIA Code: 26D2171968
  • Facility Name: GATEWAY DIRECT PRIMARY CARE JV LLC
  • Facility Address: 1574 WOODLAKE DR
    TOWN AND COUNTRY, MO
    ZIP 63017
  • Facility Phone: 314 989-2833
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JESSICA SMITH
  • NPI Number: 1154970127
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 26D2171968
LAB Type Physician Office
Facility Name GATEWAY DIRECT PRIMARY CARE JV LLC
Street 1574 WOODLAKE DR
City TOWN AND COUNTRY
State MO
ZIP 63017
Phone 314 989-2833
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/11/2025
Certificate Expiration Date 9/10/2027
Facility Type Physician Office
Lab Director JESSICA SMITH

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