14D0724597 CLIA NUMBER - HAVANA MEDICAL ASSOCIATES

Laboratory Demographics

CLIA Number: 14D0724597

Facility Name: HAVANA MEDICAL ASSOCIATES

Facility Address:
615 N PROMENADE ST
HAVANA, IL
ZIP 62644
Get Directions

Facility Phone Number: 309 543-6600

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1063478782

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0724597
LAB Type	Physician Office
Facility Name	HAVANA MEDICAL ASSOCIATES
Street	615 N PROMENADE ST
City	HAVANA
State	IL
ZIP	62644
Phone	309 543-6600
CertificateType	4
CertificateEffectiveDate	10/26/2022
CertificateExpirationDate	10/25/2024
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