14D0705758 CLIA NUMBER - SARAH BUSH LINCOLN - E M S

Laboratory Demographics

CLIA Number: 14D0705758

Facility Name: SARAH BUSH LINCOLN - E M S

Facility Address:
104 PROFESSIONAL PLAZA
MATTOON, IL
ZIP 61938
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Facility Phone Number: 217 258-2403

Facility Type: Mobile Laboratory

Certificate Type: Waiver

NPI Number: 1437277571

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	14D0705758
LAB Type	Mobile Laboratory
Facility Name	SARAH BUSH LINCOLN - E M S
Street	104 PROFESSIONAL PLAZA
City	MATTOON
State	IL
ZIP	61938
Phone	217 258-2403
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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