26D2295527 CLIA NUMBER - GREAT PLAINS ENDOCRINOLOGY & DIABETES CARE, LLC

Laboratory Demographics

CLIA Number: 26D2295527

Facility Name: GREAT PLAINS ENDOCRINOLOGY & DIABETES CARE, LLC

Facility Address:
15421 CLAYTON ROAD, SUITE 202
BALLWIN, MO
ZIP 63011
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Facility Phone Number: 636 534-1466

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1962275750

Taxonomy: 207RE0101X - Internal Medicine
An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.

CLIA Record

Field Name	Field Value
CLIA Number	26D2295527
LAB Type	Physician Office
Facility Name	GREAT PLAINS ENDOCRINOLOGY & DIABETES CARE, LLC
Street	15421 CLAYTON ROAD, SUITE 202
City	BALLWIN
State	MO
ZIP	63011
Phone	636 534-1466
CertificateType	4
CertificateEffectiveDate	12/13/2023
CertificateExpirationDate	12/12/2025
FacilityType	Waiver

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