14D0715300 CLIA NUMBER - EASTLAND MEDICAL PLAZA SURGICENTER LLC

Laboratory Demographics

CLIA Number: 14D0715300

Facility Name: EASTLAND MEDICAL PLAZA SURGICENTER LLC

Facility Address:
1505 EASTLAND DR STE 180
BLOOMINGTON, IL
ZIP 61701
Get Directions

Facility Phone Number: 309 662-3311

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1699751289

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0715300
LAB Type	Ambulatory Surgery Center
Facility Name	EASTLAND MEDICAL PLAZA SURGICENTER LLC
Street	1505 EASTLAND DR STE 180
City	BLOOMINGTON
State	IL
ZIP	61701
Phone	309 662-3311
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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