14D0430589 CLIA NUMBER - MERCYONE FULTON FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 14D0430589
  • Facility Name: MERCYONE FULTON FAMILY MEDICINE
  • Facility Address: 1705 16TH AV
    FULTON, IL
    ZIP 61252
  • Facility Phone: 815 589-2121
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. STEPHEN D. HARRISON
  • NPI Number: 1487218079
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0430589
LAB Type Physician Office
Facility Name MERCYONE FULTON FAMILY MEDICINE
Street 1705 16TH AV
City FULTON
State IL
ZIP 61252
Phone 815 589-2121
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/4/2025
Certificate Expiration Date 4/3/2027
Facility Type Physician Office
Lab Director DR. STEPHEN D. HARRISON

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