14D0431820 CLIA NUMBER - OSF MULTI-SPECIALTY GROUP

Laboratory Demographics

  • CLIA Code: 14D0431820
  • Facility Name: OSF MULTI-SPECIALTY GROUP
  • Facility Address: 5114 GLEN PARK PLACE, SUITE 220
    PEORIA, IL
    ZIP 61614
  • Facility Phone: 309 683-8100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STEPHAN SHANE
  • NPI Number: 1770125387
  • Taxonomy: 332900000X - Non-Pharmacy Dispensing Site

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CLIA Record

Field Name Field Value
CLIA Number 14D0431820
LAB Type Physician Office
Facility Name OSF MULTI-SPECIALTY GROUP
Street 5114 GLEN PARK PLACE, SUITE 220
City PEORIA
State IL
ZIP 61614
Phone 309 683-8100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2025
Certificate Expiration Date 3/21/2027
Facility Type Physician Office
Lab Director STEPHAN SHANE

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