26D2178191 CLIA NUMBER - 180 HEALTH MEDICAL AND WELLNESS CENTER

Laboratory Demographics

CLIA Number: 26D2178191

Facility Name: 180 HEALTH MEDICAL AND WELLNESS CENTER

Facility Address:
1934 S GLENSTONE
SPRINGFIELD, MO
ZIP 65804
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Facility Phone Number: 417 887-0340

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1649815796

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	26D2178191
LAB Type	Physician Office
Facility Name	180 HEALTH MEDICAL AND WELLNESS CENTER
Street	1934 S GLENSTONE
City	SPRINGFIELD
State	MO
ZIP	65804
Phone	417 887-0340
CertificateType	4
CertificateEffectiveDate	1/28/2024
CertificateExpirationDate	1/27/2026
FacilityType	Waiver

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