14D0705560 CLIA NUMBER - MODERT FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 14D0705560
  • Facility Name: MODERT FAMILY PRACTICE
  • Facility Address: #1 DOCTOR'S PARK ROAD - SUITE C
    MOUNT VERNON, IL
    ZIP 62864
  • Facility Phone: 618 244-1234
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CHRISTOPHER W. MODERT DO
  • NPI Number: 1255311700
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0705560
LAB Type Physician Office
Facility Name MODERT FAMILY PRACTICE
Street #1 DOCTOR'S PARK ROAD - SUITE C
City MOUNT VERNON
State IL
ZIP 62864
Phone 618 244-1234
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director CHRISTOPHER W. MODERT DO

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