14D0435247 CLIA NUMBER - PANA MEDICAL GROUP

Laboratory Demographics

CLIA Number: 14D0435247

Facility Name: PANA MEDICAL GROUP

Facility Address:
217 S LOCUST
PANA, IL
ZIP 62557
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Facility Phone Number: 217 562-2145

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1982159182

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0435247
LAB Type	Physician Office
Facility Name	PANA MEDICAL GROUP
Street	217 S LOCUST
City	PANA
State	IL
ZIP	62557
Phone	217 562-2145
CertificateType	3
CertificateEffectiveDate	12/23/2023
CertificateExpirationDate	12/22/2025
FacilityType	PPMP

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