26D2189146 CLIA NUMBER - DEDICATED SENIOR MEDICAL CENTER-PAGE

Laboratory Demographics

CLIA Number: 26D2189146

Facility Name: DEDICATED SENIOR MEDICAL CENTER-PAGE

Facility Address:
3649 PAGE BLVD
SAINT LOUIS, MO
ZIP 63113
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Facility Phone Number: 305 842-3910

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1558909150

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	26D2189146
LAB Type	Physician Office
Facility Name	DEDICATED SENIOR MEDICAL CENTER-PAGE
Street	3649 PAGE BLVD
City	SAINT LOUIS
State	MO
ZIP	63113
Phone	305 842-3910
CertificateType	4
CertificateEffectiveDate	7/27/2022
CertificateExpirationDate	7/26/2024
FacilityType	Waiver

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