14D0715394 CLIA NUMBER - OSF HEALTHCARE - MEDICAL GROUP - CULLOM

Laboratory Demographics

  • CLIA Code: 14D0715394
  • Facility Name: OSF HEALTHCARE - MEDICAL GROUP - CULLOM
  • Facility Address: 105 HACK ST
    CULLOM, IL
    ZIP 60929
  • Facility Phone: 815 689-2126
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: AMANDA ROBINSON
  • NPI Number: 1467178814
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D0715394
LAB Type Rural Health Clinic
Facility Name OSF HEALTHCARE - MEDICAL GROUP - CULLOM
Street 105 HACK ST
City CULLOM
State IL
ZIP 60929
Phone 815 689-2126
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/25/2023
Certificate Expiration Date 10/24/2025
Facility Type Rural Health Clinic
Lab Director AMANDA ROBINSON

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