14D0433473 CLIA NUMBER - MADISON COUNTY HEALTH DEPARTMENT

Laboratory Demographics

CLIA Code: 14D0433473
Facility Name: MADISON COUNTY HEALTH DEPARTMENT
Facility Address: 101 E EDWARDSVILLE RD
WOOD RIVER, IL
ZIP 62095
Facility Phone: 618 692-8954
Facility Type: Other - LOCAL HEALTH DEPT CLINIC
Facility Type: Microscopy
Lab Director: MARK E. MC GRANAHAN MD
NPI Number: 1982746640
Taxonomy: 251K00000X - Public Health or Welfare

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CLIA Record

Field Name	Field Value
CLIA Number	14D0433473
LAB Type	Other - LOCAL HEALTH DEPT CLINIC
Facility Name	MADISON COUNTY HEALTH DEPARTMENT
Street	101 E EDWARDSVILLE RD
City	WOOD RIVER
State	IL
ZIP	62095
Phone	618 692-8954
Certificate Type	Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description	This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date	7/16/2025
Certificate Expiration Date	7/15/2027
Facility Type	Other - LOCAL HEALTH DEPT CLINIC
Lab Director	MARK E. MC GRANAHAN MD

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