14D0429255 CLIA NUMBER - PRESENCE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 14D0429255
  • Facility Name: PRESENCE MEDICAL GROUP
  • Facility Address: 455 W COURT ST, STE 403
    KANKAKEE, IL
    ZIP 60901
  • Facility Phone: 815 939-3190
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: EDWARD KENT FRYE MD
  • NPI Number: 1215141627
  • Taxonomy: 207RH0003X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0429255
LAB Type Physician Office
Facility Name PRESENCE MEDICAL GROUP
Street 455 W COURT ST, STE 403
City KANKAKEE
State IL
ZIP 60901
Phone 815 939-3190
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/27/2025
Certificate Expiration Date 3/26/2027
Facility Type Physician Office
Lab Director EDWARD KENT FRYE MD

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