14D0435225 CLIA NUMBER - HSHS MED GROUP FAMILY MEDICINE MT ZION

Laboratory Demographics

  • CLIA Code: 14D0435225
  • Facility Name: HSHS MED GROUP FAMILY MEDICINE MT ZION
  • Facility Address: 4965 EAST LOST BRIDGE ROAD
    DECATUR, IL
    ZIP 62521
  • Facility Phone: 217 521-0515
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LARISA G. CIATLOS-DEAK
  • NPI Number: 1265752844
  • Taxonomy: 282NC2000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 14D0435225
LAB Type Physician Office
Facility Name HSHS MED GROUP FAMILY MEDICINE MT ZION
Street 4965 EAST LOST BRIDGE ROAD
City DECATUR
State IL
ZIP 62521
Phone 217 521-0515
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/17/2025
Certificate Expiration Date 8/16/2027
Facility Type Physician Office
Lab Director LARISA G. CIATLOS-DEAK

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