14D0433754 CLIA NUMBER - JCH MEDICAL GROUP JERSEY COMMUNITY HOSPITAL D/B/A

Laboratory Demographics

CLIA Number: 14D0433754

Facility Name: JCH MEDICAL GROUP JERSEY COMMUNITY HOSPITAL D/B/A

Facility Address:
414 S STATE ST
ROODHOUSE, IL
ZIP 62082
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Facility Phone Number: 618 498-7518

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1770988735

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0433754
LAB Type	Physician Office
Facility Name	JCH MEDICAL GROUP JERSEY COMMUNITY HOSPITAL D/B/A
Street	414 S STATE ST
City	ROODHOUSE
State	IL
ZIP	62082
Phone	618 498-7518
CertificateType	3
CertificateEffectiveDate	2/5/2024
CertificateExpirationDate	2/4/2026
FacilityType	PPMP

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