14D0431820 CLIA NUMBER - OSF MULTI-SPECIALTY GROUP

Laboratory Demographics

CLIA Number: 14D0431820

Facility Name: OSF MULTI-SPECIALTY GROUP

Facility Address:
5114 GLEN PARK PLACE, SUITE 220
PEORIA, IL
ZIP 61614
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Facility Phone Number: 309 683-8100

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1770125387

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

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
CertificateType	4
CertificateEffectiveDate	3/22/2023
CertificateExpirationDate	3/21/2025
FacilityType	Waiver

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