14D0691992 CLIA NUMBER - FHN FAMILY HEALTHCARE CENTER - LANARK

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Laboratory Demographics

CLIA Number: 14D0691992

Facility Name: FHN FAMILY HEALTHCARE CENTER - LANARK

Facility Address:
602 WEST OLYMPIC DRIVE
LANARK, IL
ZIP 61046
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Facility Phone Number: 815 493-2831

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1376687632

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	14D0691992
LAB Type	Physician Office
Facility Name	FHN FAMILY HEALTHCARE CENTER - LANARK
Street	602 WEST OLYMPIC DRIVE
City	LANARK
State	IL
ZIP	61046
Phone	815 493-2831
CertificateType	4
CertificateEffectiveDate	12/16/2023
CertificateExpirationDate	12/15/2025
FacilityType	Waiver

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