14D0434529 CLIA NUMBER - DEACONESS ILLINOIS CLINIC

Laboratory Demographics

  • CLIA Code: 14D0434529
  • Facility Name: DEACONESS ILLINOIS CLINIC
  • Facility Address: 509 HAMACHER ST, STE 102
    WATERLOO, IL
    ZIP 62298
  • Facility Phone: 618 939-3939
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHANNA WIGTES
  • NPI Number: 1861688541
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0434529
LAB Type Physician Office
Facility Name DEACONESS ILLINOIS CLINIC
Street 509 HAMACHER ST, STE 102
City WATERLOO
State IL
ZIP 62298
Phone 618 939-3939
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/16/2024
Certificate Expiration Date 2/15/2026
Facility Type Physician Office
Lab Director SHANNA WIGTES

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