26D2258800 CLIA NUMBER - CHRISTIAN NORTHEAST MOB1, SUITE 108N

Laboratory Demographics

  • CLIA Code: 26D2258800
  • Facility Name: CHRISTIAN NORTHEAST MOB1, SUITE 108N
  • Facility Address: 11155 DUNN ROAD, SUITE 108N
    SAINT LOUIS, MO
    ZIP 63136
  • Facility Phone: 314 286-0812
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MANASA METIREDDY
  • NPI Number: 1124416037
  • Taxonomy: 367H00000X - Anesthesiologist Assistant

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CLIA Record

Field Name Field Value
CLIA Number 26D2258800
LAB Type Physician Office
Facility Name CHRISTIAN NORTHEAST MOB1, SUITE 108N
Street 11155 DUNN ROAD, SUITE 108N
City SAINT LOUIS
State MO
ZIP 63136
Phone 314 286-0812
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/27/2024
Certificate Expiration Date 4/26/2026
Facility Type Physician Office
Lab Director MANASA METIREDDY

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