26D2202493 CLIA NUMBER - BIG TREE MEDICAL HOME-BOLIVAR

Laboratory Demographics

  • CLIA Code: 26D2202493
  • Facility Name: BIG TREE MEDICAL HOME-BOLIVAR
  • Facility Address: 626 SOUTH SPRINGFIELD AVE
    BOLIVAR, MO
    ZIP 65613
  • Facility Phone: 573 814-1170
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ADAM D. WHEELER
  • NPI Number: 1619577905
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 26D2202493
LAB Type Physician Office
Facility Name BIG TREE MEDICAL HOME-BOLIVAR
Street 626 SOUTH SPRINGFIELD AVE
City BOLIVAR
State MO
ZIP 65613
Phone 573 814-1170
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/28/2024
Certificate Expiration Date 11/27/2026
Facility Type Physician Office
Lab Director ADAM D. WHEELER

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