26D2322769 CLIA NUMBER - VITALMEDIX SUPPLIES LLC

Laboratory Demographics

  • CLIA Code: 26D2322769
  • Facility Name: VITALMEDIX SUPPLIES LLC
  • Facility Address: 10616 E WINNER RD
    INDEPENDENCE, MO
    ZIP 64052
  • Facility Phone: 872 331-8174
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: MOHAMMED MOHIUDDIN AHMED
  • NPI Number: 1053109710
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 26D2322769
LAB Type Independent
Facility Name VITALMEDIX SUPPLIES LLC
Street 10616 E WINNER RD
City INDEPENDENCE
State MO
ZIP 64052
Phone 872 331-8174
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/25/2025
Certificate Expiration Date 4/24/2027
Facility Type Independent
Lab Director MOHAMMED MOHIUDDIN AHMED

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