14D0431735 CLIA NUMBER - OSF HEALTHCARE - MED GROUP - ROANOKE

Laboratory Demographics

  • CLIA Code: 14D0431735
  • Facility Name: OSF HEALTHCARE - MED GROUP - ROANOKE
  • Facility Address: 401 N MAIN ST
    ROANOKE, IL
    ZIP 61561
  • Facility Phone: 309 923-2661
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: BRAD A. STOECKER
  • NPI Number: 1164138848
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D0431735
LAB Type Rural Health Clinic
Facility Name OSF HEALTHCARE - MED GROUP - ROANOKE
Street 401 N MAIN ST
City ROANOKE
State IL
ZIP 61561
Phone 309 923-2661
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/4/2024
Certificate Expiration Date 10/3/2026
Facility Type Rural Health Clinic
Lab Director BRAD A. STOECKER

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