14D0725142 CLIA NUMBER - ROSSVILLE RURAL HEALTH CLINIC

Laboratory Demographics

CLIA Number: 14D0725142

Facility Name: ROSSVILLE RURAL HEALTH CLINIC

Facility Address:
619 N CHICAGO ST
ROSSVILLE, IL
ZIP 60963
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Facility Phone Number: 217 748-4141

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1629295324

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0725142
LAB Type	Rural Health Clinic
Facility Name	ROSSVILLE RURAL HEALTH CLINIC
Street	619 N CHICAGO ST
City	ROSSVILLE
State	IL
ZIP	60963
Phone	217 748-4141
CertificateType	4
CertificateEffectiveDate	4/7/2024
CertificateExpirationDate	4/6/2026
FacilityType	Waiver

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