26D2196798 CLIA NUMBER - BLUETAIL MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 26D2196798
  • Facility Name: BLUETAIL MEDICAL GROUP
  • Facility Address: 17300 N OUTER 40 RD STE 201
    CHESTERFIELD, MO
    ZIP 63005
  • Facility Phone: 636 778-2822
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PHEBE L. MOORE
  • NPI Number: 1639645070
  • Taxonomy: 207QS0010X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 26D2196798
LAB Type Physician Office
Facility Name BLUETAIL MEDICAL GROUP
Street 17300 N OUTER 40 RD STE 201
City CHESTERFIELD
State MO
ZIP 63005
Phone 636 778-2822
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/20/2024
Certificate Expiration Date 10/19/2026
Facility Type Physician Office
Lab Director PHEBE L. MOORE

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