14D0432270 CLIA NUMBER - CENTRAL ILLINOIS PEDIATRICS ASSOC

Laboratory Demographics

CLIA Number: 14D0432270

Facility Name: CENTRAL ILLINOIS PEDIATRICS ASSOC

Facility Address:
2427 MALONEY DRIVE
BLOOMINGTON, IL
ZIP 61704
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Facility Phone Number: (309) 663-1011

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1174706816

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0432270
LAB Type	PHYSICIAN OFFICE
Facility Name	CENTRAL ILLINOIS PEDIATRICS ASSOC
Street	2427 MALONEY DRIVE
City	BLOOMINGTON
State	IL
ZIP	61704
Phone	(309) 663-1011

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This page was last updated on: 5/11/2023