14D0664194 CLIA NUMBER - OSF MULTI-SPECIALTY GROUP - COLLEGE AVE LAB

Laboratory Demographics

  • CLIA Code: 14D0664194
  • Facility Name: OSF MULTI-SPECIALTY GROUP - COLLEGE AVE LAB
  • Facility Address: 1701 E COLLEGE AVE
    BLOOMINGTON, IL
    ZIP 61704
  • Facility Phone: 309 664-3842
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GUSTAVO A. GALUE
  • NPI Number: 1487881058
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0664194
LAB Type Physician Office
Facility Name OSF MULTI-SPECIALTY GROUP - COLLEGE AVE LAB
Street 1701 E COLLEGE AVE
City BLOOMINGTON
State IL
ZIP 61704
Phone 309 664-3842
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/26/2025
Certificate Expiration Date 4/25/2027
Facility Type Physician Office
Lab Director GUSTAVO A. GALUE

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