14D0429411 CLIA NUMBER - GIBSON CITY CLINIC SC

Laboratory Demographics

  • CLIA Code: 14D0429411
  • Facility Name: GIBSON CITY CLINIC SC
  • Facility Address: 222 NORTH SANGAMON
    GIBSON CITY, IL
    ZIP 60936
  • Facility Phone: 217 784-8148
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DAVID J. HAGAN
  • NPI Number: 1386903946
  • Taxonomy: 261Q00000X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D0429411
LAB Type Physician Office
Facility Name GIBSON CITY CLINIC SC
Street 222 NORTH SANGAMON
City GIBSON CITY
State IL
ZIP 60936
Phone 217 784-8148
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director DAVID J. HAGAN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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