14D0431141 CLIA NUMBER - OSF HEALTHCARE - MEDICAL GROUP - STREATOR

Laboratory Demographics

CLIA Number: 14D0431141

Facility Name: OSF HEALTHCARE - MEDICAL GROUP - STREATOR

Facility Address:
111 SPRING ST - FL 4
STREATOR, IL
ZIP 61364
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Facility Phone Number: 815 672-4587

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1891399432

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0431141
LAB Type	Physician Office
Facility Name	OSF HEALTHCARE - MEDICAL GROUP - STREATOR
Street	111 SPRING ST - FL 4
City	STREATOR
State	IL
ZIP	61364
Phone	815 672-4587
CertificateType	4
CertificateEffectiveDate	12/23/2023
CertificateExpirationDate	12/22/2025
FacilityType	Waiver

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