14D0664668 CLIA NUMBER - CARLE HEALTH EAST PEORIA ON WASHINGTON

Laboratory Demographics

  • CLIA Code: 14D0664668
  • Facility Name: CARLE HEALTH EAST PEORIA ON WASHINGTON
  • Facility Address: 2535 E WASHINGTON
    EAST PEORIA, IL
    ZIP 61611
  • Facility Phone: 309 694-6464
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARK MONTEFOLKA
  • NPI Number: 1124130208
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D0664668
LAB Type Physician Office
Facility Name CARLE HEALTH EAST PEORIA ON WASHINGTON
Street 2535 E WASHINGTON
City EAST PEORIA
State IL
ZIP 61611
Phone 309 694-6464
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director MARK MONTEFOLKA

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