14D0435490 CLIA NUMBER - MEMORIAL PHYSICIAN SERVICES - LINCOLN

Laboratory Demographics

  • CLIA Code: 14D0435490
  • Facility Name: MEMORIAL PHYSICIAN SERVICES - LINCOLN
  • Facility Address: 515 NORTH COLLEGE STREET
    LINCOLN, IL
    ZIP 62656
  • Facility Phone: 217 732-9681
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AMIR JOHN WAHAB
  • NPI Number: 1477614105
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D0435490
LAB Type Physician Office
Facility Name MEMORIAL PHYSICIAN SERVICES - LINCOLN
Street 515 NORTH COLLEGE STREET
City LINCOLN
State IL
ZIP 62656
Phone 217 732-9681
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2024
Certificate Expiration Date 4/27/2026
Facility Type Physician Office
Lab Director AMIR JOHN WAHAB

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