14D0431295 CLIA NUMBER - MERCYONE GHG ALPHA FAMILY PRACTICE CLINIC

Laboratory Demographics

  • CLIA Code: 14D0431295
  • Facility Name: MERCYONE GHG ALPHA FAMILY PRACTICE CLINIC
  • Facility Address: 202 PICARD ST
    ALPHA, IL
    ZIP 61413
  • Facility Phone: 309 629-4601
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBERT PADGETT
  • NPI Number: 1205942083
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0431295
LAB Type Physician Office
Facility Name MERCYONE GHG ALPHA FAMILY PRACTICE CLINIC
Street 202 PICARD ST
City ALPHA
State IL
ZIP 61413
Phone 309 629-4601
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director ROBERT PADGETT

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